Saakshi Khattri, MD, is a board certified Dermatologist, Rheumatologist and Internist and one of only a handful of triple board-certified physicians across the US.

Saakshi Khattri, MD, FACR, FAAD

Saakshi Khattri, MD, describes how risk factors for psoriatic arthritis influence her decision to use IL-23 inhibitors such as risankizumab as first-line systemic therapy in psoriasis.

First-Line Biologic Selection in High-Risk Psoriasis: The Role of IL-23 Inhibition

In this segment, Saakshi Khattri, MD, addresses how the emerging data on PsA risk reduction with risankizumab informs first-line biologic selection in patients with psoriasis who have recognized risk factors for PsA. She highlights that patients with nail disease, scalp involvement, intertriginous psoriasis, a family history of PsA, obesity, and smoking history may carry a higher likelihood of progression from skin-only disease to joint involvement. Even in the setting of limited body surface area (BSA) involvement, she considers these risk factors when deciding whether to initiate systemic therapy.

Khattri notes that real-world data suggesting a lower incidence of PsA with IL-23 inhibition have meaningfully influenced her clinical practice. Although the evidence is retrospective and subject to inherent limitations, she reports an increasing tendency to use IL-23 inhibitors, including risankizumab, as first-line biologic therapy for appropriate psoriasis patients, particularly those deemed at higher risk for PsA. This shift reflects both the biologic rationale for targeting IL-23 and the signal that this pathway may be associated with reduced transition from skin disease to joint disease.

As a rheumatologist, Khattri also underscores the importance of ongoing vigilance for early joint symptoms, regardless of the systemic agent chosen. She routinely performs joint examinations, evaluates for enthesitis and dactylitis, and asks about morning stiffness at each visit.

For patients with psoriasis but no established PsA, she views IL-23 inhibition as a compelling option, while emphasizing that careful musculoskeletal assessment remains essential to detect PsA early should it develop.

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Saakshi Khattri, MD, discusses how real-world comparative effectiveness data suggest a potential class-level signal for risankizumab and IL-23 inhibition in reducing the risk of psoriatic arthritis among patients with psoriasis.

Real-World Data on Risankizumab and Psoriatic Arthritis Prevention in Psoriasis

In this discussion, Saakshi Khattri, MD, a rheumatologist and dermatologist at the Icahn School of Medicine at Mount Sinai, reviews emerging real-world evidence on risankizumab in psoriatic disease, with a focus on psoriatic arthritis (PsA) prevention. She notes that for clinicians managing patients with psoriasis, the possibility of reducing PsA risk is a central concern, yet prospective prevention trials directly comparing mechanisms of action (MOAs) are lacking. In this context, real-world comparative effectiveness data have become an important—albeit imperfect—source of insight.

Khattri explains that analyses of real-world datasets suggest patients with psoriasis treated with risankizumab are less likely to develop PsA than those receiving other targeted immunomodulators. She emphasizes that these findings are based on observational claims and registry data, not on prospective prevention trials, and therefore must be interpreted cautiously.

Nonetheless, in the absence of randomized data, she considers “any data better than no data,” particularly when it consistently signals a lower incidence of PsA in association with IL-23 inhibition.

From a mechanistic standpoint, Khattri points out that IL-23 is a key upstream cytokine implicated in both cutaneous and joint inflammation in psoriatic disease. Blocking IL-23 may therefore be biologically plausible as a strategy to blunt progression from skin-only psoriasis to PsA.

While she underscores that these findings do not establish proof of prevention, she reports that this emerging signal influences her systemic therapy selection for patients who currently have psoriasis alone but are at risk for future PsA.

The Medical Sisterhood: The Strength Nobody Talks About, with Saakshi Khattri, MD

 podcast, host Mona Shahriari, MD, associate clinical professor of 

 at Yale University and practicing dermatologist in Connecticut, sat down with Saakshi Khattri, MD, a triple board-certified physician in dermatology, rheumatology, and internal medicine, associate professor at the Icahn School of Medicine at Mount Sinai, and director of Mount Sinai’s Dermatology/Rheumatology service. Together, the 2 physicians explored themes of reinvention, contentment, boundaries, and redefining success for women in medicine.

The conversation centered on the idea that personal and professional growth often requires letting go of earlier definitions of achievement. Reflecting on her career, Khattri noted that her priorities have changed significantly over time. While she once focused heavily on academic accomplishments and professional milestones, she now views contentment, not achievement, as the more meaningful goal. For Khattri, contentment can take many forms, ranging from meaningful work and relationships to simple daily pleasures, emphasizing that fulfillment often evolves throughout different stages of life.

Shahriari and Khattri discussed how expectations placed on women can shape perceptions of success and self-worth. Khattri reflected on how many women are conditioned to seek external validation, whether through career accomplishments, societal expectations, or personal milestones. She argued that fulfillment is more likely to come from defining success internally rather than allowing others to dictate what achievement should look like.

A major theme of the episode involved reinvention. Khattri described how her own life unfolded differently than she once imagined, recalling that as a young medical student she envisioned a future centered around marriage and a large family. Instead, her career, personal experiences, and changing priorities led her down a very different path. She emphasized that evolution is a natural part of life and that individuals should not feel obligated to remain tied to goals or identities formed decades earlier.

The discussion also explored how personal adversity can alter perspective. Khattri shared that a breast cancer diagnosis in her late 30s became a turning point, prompting her to reassess what truly mattered and encouraging a greater focus on joy, purpose, and personal values. She explained that experiences like serious illness can shift attention away from external markers of success and toward a deeper appreciation of life’s priorities.

Another recurring topic was the importance of boundaries. Khattri argued that physicians, particularly women, are often not taught how to establish limits in their professional lives.

 She recounted experiences involving patient expectations and professional obligations that reinforced the necessity of protecting personal time and wellbeing. Both she and Shahriari acknowledged that learning to say “no” can be difficult, but described it as essential for long-term sustainability and happiness.

The pair also addressed vulnerability among high-achieving women. Khattri noted that many women feel pressure to appear strong and composed in professional settings, often suppressing emotions out of concern that vulnerability could be perceived as weakness. While she emphasized the importance of having safe outlets through family, friends, or therapy, she acknowledged that these expectations remain deeply ingrained.

As the episode concluded, Khattri offered advice for the next generation of women physicians: seek validation from within, establish boundaries early, and define success according to personal values rather than societal expectations. Ultimately, both physicians framed reinvention not as failure, but as an ongoing process of growth, self-discovery, and becoming more fully aligned with one’s authentic self.

Neither speak had any notable disclosures of note

Editor’s note: This episode was produced with the help of AI tools.

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Wang ML, Narcisse MR, Rodriguez K, McElfish PA. Gender disparities in job flexibility, job security, psychological distress, work absenteeism, and work presenteeism among U.S. adults. SSM Popul Health. 2025 Feb 3;29:101761. 

Podcasts

This June episode of the podcast highlights one clinicians journey and experiences as a woman physician in the dermatology and rheumatology fields.

In this episode, the panelists review long-term efficacy data for bimekizumab presented at EADV 2025, focusing on sustained remission and disease control in psoriasis. The experts highlight that approximately 49% of patients maintained complete skin clearance (PASI 100) from month 4 through year 4, with about 72% sustaining complete or near-complete clearance over the same period. They interpret these findings as strong evidence of durability and depth of response, underscoring bimekizumab’s ability to maintain remission over years rather than months. The discussion also includes nail outcomes, with nearly 80% of patients maintaining NAPSI 0, indicating resolution of nail involvement—an important factor given its association with psoriatic arthritis risk. The panelists emphasize that by achieving and maintaining high levels of clearance in both skin and nails, bimekizumab may help interrupt the inflammatory progression that leads to PsA, reinforcing its role in comprehensive disease control.

Saakshi Khattri, MD, FACR, FAAD

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