Tips for Treating PsA in Patients With Psoriasis

With about 30% of psoriasis patients able to develop psoriatic arthritis, it's important that dermatologists play an active role in screening. Elizabeth B. Wallace, MD, FAAD, discusses how dermatologists can go about detecting if psoriasis patients have psoriatic arthritis by suggesting tips, tricks, and tools that can be used to identify and manage psoriatic arthritis. 

Dr Wallace is an assistant professor of dermatology in the department of dermatology at University of Colorado School of Medicine and Anschutz Medical Campus in Aurora. She is also the co-director of the Connective Tissue Disease Program, co-founder of the Rheumatology-Dermatology clinic, and assistant director of Clinical Trials.

Transcript:

Dr Wallace: First of all, about 30% of psoriasis patients will develop psoriatic arthritis. The onset is usually about 10 to 11 years after the psoriasis presents. We know that psoriasis is the greatest risk factor for development of psoriatic arthritis and that certain areas of psoriasis involvement can confer greater risk of developing psoriatic arthritis.

Since the psoriasis patients are presenting to us as dermatologists first, it's important that we play a role in screening. The other important point for a dermatologist is that we make patients aware that this connection exists.

We give them the signs and symptoms to look out for and say, "Hey, don't hesitate to give the office a call if you start getting these symptoms," because we know a delay in diagnosis of as little as six months can lead to permanent joint damage. We want to be detecting these patients very early.

In my clinic, I use the PEST tool. The PEST is a very easy and straightforward tool to implement in a busy clinic. It consists of five questions, and a score of three or higher may be indicative that your patient has psoriatic arthritis.

That could be one easy tool that the dermatologist implements to raise the alert or the alarms that, "Hey, we need to consider our treatment in the context of this patient potentially having psoriatic arthritis."

Then the other thing we mentioned was that we don't have a diagnostic test. The National Psoriasis Foundation has a grant and initiative to develop a diagnostic test. There are six project proposals currently underway in year one to work towards achieving the goal of finding a diagnostic test in psoriatic arthritis.

Right now, though, it's putting a lot of things together, taking a good history, taking a look at the joints, sometimes looking at labs, or ordering imaging. The dermatologists can do those things they can take a history, personal and family history. We know that family history of psoriatic arthritis is a risk factor for development of psoriatic arthritis in our patients.

Keeping that thought in the back of the mind. Ordering some inflammatory markers and just knowing what inflammatory joint disease sounds like. It's pain, stiff, swollen joints. Usually worse in the morning and better throughout the day with activity.

Then also becoming familiar with the different treatment guidelines. We have great treatment guidelines for psoriasis and also for psoriatic arthritis.

Finally, knowing that psoriatic arthritis can present in the joints of the hands, they can present in the small joints, they can present in the back with axial disease. You can get other inflammatory soft tissues involved, like entheseal points.

Again, having that awareness and becoming familiar with some of the different treatment options for patients with psoriatic arthritis, namely a lot of the biologics. I'm very lucky to be in part of a combined rheumatology dermatology clinic that we hold twice a month.

I have the opportunity to drown my rheumatology colleagues often but I know that's not the case everywhere. Hopefully, those are some tips, tricks, and tools that the dermatologist can have in their tool belt to help identify and manage psoriatic arthritis.