Management of psoriatic arthritis from the view of the dermatologist

• Published in: Nature reviews. Rheumatology Vol. 7; no. 10; pp. 588 - 598
• Main Authors: Gottlieb, Alice B, Chang, Caroline A, Lizzul, Paul F
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-10-2011; Nature Publishing Group
• Subjects: 692/699/1670/2766/1900; 692/700/139; 692/700/565; Arthritis, Psoriatic - diagnosis; Arthritis, Psoriatic - drug therapy; Care and treatment; Dermatologists; Dermatology; Diagnosis; Disease Progression; Family medical history; Humans; Laboratories; Medical education; Medicine; Medicine & Public Health; Patient outcomes; Patients; Practice; Practice guidelines (Medicine); Practice Guidelines as Topic; Product development; Psoriasis; Psoriatic arthritis; Quality of life; Questionnaires; review-article; Rheumatology; Risk factors; Skin diseases; United States; United States > US
• ISSN: 1759-4790; 1759-4804
• DOI: 10.1038/nrrheum.2011.125

Untreated psoriatic arthritis can have severe long-term consequences, and patients benefit from early intervention. The disease typically presents as psoriasis initially, so dermatologists are ideally placed to manage such interventions, and should coordinate with rheumatologists to ensure optimum patient care. Treatment guidelines and assessment tools from dermatology consortia are among the patient management aspects discussed in this Review.
Psoriatic arthritis (PsA) is an inflammatory seronegative spondyloarthropathy associated with psoriasis. Although the main assessment measures for PsA are borrowed from the standard criteria used to assess rheumatoid arthritis, a number of new criteria such as the PsAJAI and CPDAI are being developed specifically for PsA. Long-term consequences of untreated PsA include persistent inflammation, progressive joint damage and, in many cases, substantial functional limitations, pain and disability. Moreover, patients with PsA have an increased mortality risk and an increased risk of developing cardiovascular disease and metabolic syndrome. Both GRAPPA and the AAD have developed treatment guidelines, which are discussed here. Psoriasis commonly precedes arthritic symptoms; thus, dermatologists are ideally placed to make the initial diagnosis of PsA and treat it appropriately, affording the opportunity to slow disease progression, improve physical function and enhance quality of life. This Review explores the management of patients with PsA, with a particular emphasis on assessment tools, long-term consequences and treatment issues from the viewpoint of the dermatologist.
Key Points
Dermatologists are ideally placed to diagnose and treat psoriatic arthritis (PsA), as most patients present with skin symptoms before onset of arthritis
PsA is a potentially debilitating and destructive disease that should be treated as soon as possible after diagnosis to prevent irreversible damage
Patients with mild PsA can be managed with NSAIDs; however, systemic corticosteroids should be used cautiously in such cases
Moderate-to-severe cases of PsA can be managed by DMARDs or TNF inhibitors, administered either alone or in combination
Promising new drugs for the treatment of PsA include ustekinumab and abatacept