How the New PsA Guidelines Impact Dermatologists

PsA

Approximately 30% of psoriasis (PsO) patients develop psoriatic arthritis (PsA),1 which can appear with mild, moderate, or severe PsO. Dermatologists are often the first health care providers to both screen and make the diagnosis. Our goal is to diagnose PsA as early as possible to prevent permanent joint damage and disability. 

In a Denmark nationwide cohort study using data over 16 years, patients with PsA were more likely than controls to be on disability 5 years prior to their diagnosis.2 A decade after diagnosis, approximately 22% of patients with PsA were collecting disability. 

Early and effective treatment of PsA is crucial to reduce joint damage, prevent disability, improve quality of life and reduce overall health care costs. In my practice I screen all PsO patients for evidence of early signs or symptoms of PsA at every office visit. 

If patients with moderate to severe PsO also have active PsA, the new guidelines suggest using tumor necrosis factor (TNF)-⍺ inhibitors as first line therapy unless contraindicated.3 This is consistent with my current practice. I think it is helpful for those of us who see patients with PsO to have these published guidelines given that so many new biologic and systemic drugs are now available.

Knowing where to start and how to proceed if there is failure or contraindications is also of benefit. There are very few head to head studies confirming which treatments have the greatest efficacy, therefore having a consensus opinion of our current data was needed.  

Dr Prussick is a clinical assistant professor of dermatology at George Washington University in Washington, DC.

References

1. Spelman L, Su JC, Fernandez-Penas P, et al.  Frequency of undiagnosed psoriatic arthritis among psoriasis patients in Australian dermatology practice. J Eur Acad Dermatol Venerol. 2015;29(11):2184-2191.

2. Kristensen LE, Jorgensen TS, Christensen R, et al.  Societal costs and patients experience of health inequities before and after diagnosis of psoriatic arthritis. Ann Rheum Dis. 2017;76(9):1495-1501.

3. Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol. 2019;71(1):5-32.