Targeting Structural Damage in Psoriatic Arthritis: The Impact of Early Recognition and Timely Intervention - Episode 4
Enhancing Psoriatic Arthritis Care Through Multispecialty Collaboration
Experts discuss the frequent delay in psoriatic arthritis (PsA) diagnosis that leads to irreversible joint damage, emphasizing the pivotal role of dermatologists in early detection, the value of screening tools and public education, and the potential of early systemic psoriasis treatment to reduce PsA risk. They highlight the need for proactive, collaborative care to prevent long-term disability.
Many patients with PsA present to the rheumatology department with irreversible structural joint damage already present. This often results from a delayed diagnosis, either because they were initially treated solely for their psoriasis or due to a lack of awareness about the link between psoriasis and PsA. In some cases, patients do not realize that their joint pain might be related to their skin condition. Additionally, limited access to care, financial barriers, or a lack of insurance can prevent early intervention, further increasing the risk of long-term disability, including joint deformities and spinal fusion.
Dermatologists play a critical role in the early identification of PsA because most patients first present with skin disease. Tools such as the Psoriasis Epidemiology Screening Tool questionnaire can help identify those at risk during routine dermatology visits. However, time constraints, competing priorities in busy clinics, or limited rheumatology access in rural areas may prevent timely referral. Even so, growing awareness among dermatologists, and integrated electronic health record prompts, are helping to improve early detection and streamline referrals when symptoms such as prolonged morning stiffness, reduced range of motion, or joint pain occur.
Public awareness campaigns have also become essential in empowering patients to recognize potential symptoms of PsA and advocate for themselves. Educational outreach from foundations, television segments, and online resources can prompt individuals to seek care earlier. In some cases, patients bring their suspicions to providers after engaging with these resources. Additionally, evidence is emerging that early treatment of psoriasis with systemic therapies, especially in patients with risk factors such as nail involvement, obesity, or depression, may reduce the incidence of PsA. This suggests that aggressive management of psoriasis may help protect the joints as well as the skin, reinforcing the need for proactive, collaborative care between dermatology and rheumatology departments.
