Risk of Psoriatic Arthritis Development in Patients with Subclinical PsA

A recent study published in RMD Open, evaluating patients with psoriasis (PsO) and subclinical psoriatic arthritis (PsA), highlights the elevated risk of developing PsA in this population. The findings emphasize the importance of monitoring musculoskeletal symptoms in patients with PsO to facilitate early detection and intervention.

The study followed 384 patients with PsO for an average of 33 months, with 311 (80.9%) classified as having subclinical PsA. The PsA incidence rate was 7.7 per 100 patient-years, and patients with subclinical PsA had a significantly higher risk of developing PsA than those without musculoskeletal symptoms (HR=11.7; 95% CI, 1.57-86.7; P=0.016).

"The probability of new-onset PsA estimated by the cumulative incidence function was 9.4% at 12 months and 22.7% at 36 months," the study reported. This underscores the need for dermatologists to actively assess musculoskeletal symptoms in patients with PsO.

Among those who progressed to PsA, 58.9% experienced inflammatory symptoms, such as morning stiffness and joint pain, in the months leading up to diagnosis. However, 83.9% had experienced non-inflammatory symptoms, such as mechanical joint pain or fatigue, prior to their PsA diagnosis.

Peripheral joint swelling was the most common initial presentation of PsA, occurring in 82.1% of cases. "Joint swelling was the dominant feature in new-onset PsA, likely reflecting clinical confidence in recognizing joint swelling," the study noted.

These findings highlight the need for increased vigilance in patients with PsO and musculoskeletal symptoms, even in the absence of overt inflammation. Early identification and intervention may help modify disease progression and improve long-term outcomes for patients at risk of PsA.

Reference
Zabotti A, Fagni F, Gossec L, et al. Risk of developing psoriatic arthritis in psoriasis cohorts with arthralgia: exploring the subclinical psoriatic arthritis stage. RMD Open. Published online April 10,2024. doi:10.1136/rmdopen-2024-004314