Latest EULAR points-to-consider may help discover people susceptible to psoriatic arthritis

The transition from psoriasis to PsA – and the early diagnosis of PsA – is of considerable scientific and clinical interest. People typically have psoriatic skin disease for a decade or more before they start to experience the joint involvement of PsA. Understanding more concerning the natural history and trajectory of this disease will assist in the longer term prevention of PsA, in addition to shed more light on possible risk aspects and predictors.

The brand new EULAR points-to-consider were developed by a multidisciplinary task force of 30 members from 13 European countries, with health care professionals from rheumatology and dermatology, in addition to methodologists and patient research partners. The work was accomplished in step with EULAR standardized operating procedures. All information included in the ultimate paper – published within the month of June 2023 issue of the Annals of the Rheumatic Diseases – was based on two systematic literature reviews plus expert consensus.

Overall, 5 overarching principles and 10 points-to-consider were formulated. The principles acknowledge that folks with psoriasis may develop PsA at different times – or in no way – and highlight that there’s a need for close collaboration between dermatologists and rheumatologists – although the rheumatologist has a key role in PsA diagnosis and management. In addition they stress that having the ability to discover risk aspects for PsA may influence therapy selections in individuals with psoriasis, especially since certain systemic treatments for psoriasis may reduce the chance of transition to PsA.

The points-to-consider highlight arthralgia (joint pain) and abnormalities seen on ultrasound or MRI (magnetic resonance imaging) as key elements of subclinical PsA that may potentially be used as short-term predictors of who will go on to develop PsA. This also makes these elements useful to assist design clinical trials PsA interception and prevention. Traditional risk aspects for PsA development comparable to psoriasis severity, obesity and nail involvement may represent more long-term disease predictors. As such, these are felt to be less useful for short-term trials investigating the transition from psoriasis to PsA.

The duty force also proposed some standard naming for 3 distinct stages in PsA development. Firstly, individuals with psoriasis at higher risk of PsA, then individuals with subclinical PsA, after which individuals with clinical PsA. This is vital, because it has been shown in other inflammatory rheumatic musculoskeletal diseases that clinical onset is preceded by a preclinical phase where an individual has arthralgia and immunological or imaging abnormalities, within the absence of a clinical diagnosis. The duty force also proposed a definition for early psoriatic arthritis based on the event of joint swelling as a clinical consequence measure for trials of PsA prevention.

EULAR hopes this publication will help to define the clinical and imaging features of individuals with psoriasis who should raise clinical suspicion for progression to PsA. In addition they hope it will probably be used to discover individuals who may benefit from a therapeutic intervention to delay or prevent PsA. Within the meantime, individuals with psoriasis needs to be informed concerning the risk of developing PsA and encouraged to report their symptoms to facilitate early PsA recognition.