Psoriatic arthritis is increasingly perceived as a common disease that causes progressive joint damage and disability. With earlier recognition and diagnosis, clinicians have the chance to intervene before significant permanent damage has occurred, reducing long-term disability and enhancing quality of life. With skin disease typically developing much earlier than joint disease, dermatologists can play a key role in identifying the onset of PsA. Dermatologists will frequently be the first physicians to recognize a diagnosis of PsA and will need to work closely with rheumatologists to establish the diagnosis and select treatments that will address both the skin and the joint disease. Cooperative management, with input from both specialties, will result in the most efficient and effective care for both the skin and joint manifestations of this disease. Newer therapeutic agents, such as the TNF-α antagonists and other biologic response modifiers, offer the potential for improved efficacy without some of the toxicities that have limited traditional therapies. However, these agents are not for all patients. As with the use of these agents in psoriatic skin disease, the financial cost of these agents is high. Patients with mild joint symptoms or only a few involved joints may not require biologic agents to manage their arthritis, sparing them both the cost and the potential toxicity. On the other hand, those with aggressive, destructive disease would benefit from effective treatment before they develop permanent joint damage. Ongoing research into the epidemiology and outcomes of PsA can provide insight into the patient characteristics, such as multiple involved joints, that may be indicators of poor outcomes. Appropriate patient selection will be critical to ensure that resources are used wisely on patients who will benefit, and that those who would benefit the most are treated appropriately.
ASJC Scopus subject areas