Practice Management of Psoriasis and Psoriatic Arthritis

On the first day of Spring Dermatology Week 2023, Joseph F. Merola, MD, MMSc, and Joel M. Gelfand, MD MSCE, reviewed the pathogenesis in both joints and skin, and what may be down the pipeline for clinical treatment of psoriasis and psoriatic arthritis during their session, “Towards More Comprehensive Care of Psoriasis.”

First, Dr Merola reminded his dermatology colleagues that when thinking about pathogenesis in the joints, all the same key players are there which are familiar within skin pathogenesis. “All of the same cytokines, a lot of the same molecular and then cellular players look very familiar to you if you know the skin side of this story,” he stated. However, he did note there is a bit of a difference. Many of the same effectors for both molecules and cells are now impacting the joint, synovium, and enthesis.

He transitioned into how dermatologic therapeutics that work for the skin could also work for the joints. He shared that up to one-third of dermatology patients with psoriasis will go on to develop psoriatic arthritis. Additionally, most patients with psoriatic arthritis will experience some skin disease before joint disease. Patients who are at risk for developing psoriatic arthritis and seeing dermatologists need screening for psoriatic arthritis, especially those who are being treated for psoriasis because this is important before choosing a topical, oral, or systemic therapy.

Dr Gelfand echoed his agreement by noting that clinical practice management and an efficiency in clinical practices are needed to achieve this, and physicians must have a practice set up to do so. Currently, most practices would find it hard to operationalize.

“Hopefully, with EMRs [electronic medical records] and artificial intelligence, a day should come when a patient makes an appointment, they have a diagnosis of psoriasis, the EMR spits out the survey to them, they fill it out, and then we get a trigger like a lab alert setting,” he concluded.

For more meeting coverage, visit the Spring Dermatology Week 2023 newsroom.

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Reference
Merola JF, Gelfand JM. Towards more comprehensive care of psoriasis. Presented at: Dermatology Week 2023; May 3–6, 2023; Virtual.