Psoriasis and Psoriatic Arthritis: Emphasis on Comprehensive Care

On the final day of Fall Dermatology Week 2023, Joseph F. Merola, MD, MMSc, and Joel M. Gelfand, MD, MSCE, shared what a more comprehensive care experience means, and how physicians can build trust with their patients during their session, “Towards More Comprehensive Care of Psoriasis.”

To start, Dr Gelfand highlighted a study in which dermatologists were seeing patients with psoriasis and then, on their way out the door, a rheumatologist would have an opportunity to examine the patient and decide whether they might have psoriatic arthritis.

“In fact, at least in this study, 41%, not a small number, of patients were given the new diagnosis of psoriatic arthritis who didn't previously have it. And we've seen this number a few times over in terms of patients with musculoskeletal symptoms and such. About 40% may be undiagnosed, so not uncommon, likely, and certainly happening in our clinics,” he noted.

Dr Merola added that he liked this study, noting that this could be a challenging diagnosis to make. He shared that there are times when even rheumatologists may argue about when a patient truly has psoriatic arthritis, and this emphasizes why it is important for dermatologists to have an algorithm to turn to.

“I think, as a proxy, clinical dermatologist managing psoriasis, you want to make sure you're well-connected with a good rheumatologist, so you know who to send a patient to when you're dealing with this challenge,” he added.

Next, Dr Gelfand took a deeper dive into psoriatic arthritis, noting its pain, stiffness, limited mobility potentially in the joints, and reduced range of motion.  Psoriatic arthritis can deform joints, with around 40% to 60% of patients experiencing this outcome.

“It's also important to know [psoriasis and psoriatic arthritis] are not mutually exclusive and a patient can evolve over time,” he added.

They concluded by emphasizing the importance of asking every patient about psoriatic arthritis during the visit, noting that such questions should center around pain in the joints, stiffness, and how this stiffness affects daily activities.

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

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Reference
Merola JF, Gelfand JM. Towards more comprehensive care of psoriasis. Presented at: Dermatology Week 2023; September 20-23, 2023; Virtual.