How Psoriatic Arthritis Presentation, Treatment Has Evolved

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Benjamin J. Smith, DMSc, PA-C, discusses the importance of defining comorbidities in diagnosing PsA, as well as prescribing biologics.

Approximately ≥130 people per 100,000 are affected with psoriatic arthritis (PsA), though that prevalence has been shown to be increasing in this last decade concurrently with the rate of plaque psoriasis in the global population.1

The rising rate of the chronic, debilitating condition of PsA is frequently combated by the highly evidenced armamentarium of treatment options available for patients—primarily, biologic agents and other targeted therapies that have become as commonplace in treatment regimens as the decades-long standard steroid therapies.

But the next greatest tool a clinician may have in managing newly diagnosed PsA is a greater awareness of its manifestation, comorbidities, and reaction to these suggested therapies. In an interview with HCPLive during the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston, TX, last week, Benjamin J. Smith, DMSc, PA-C, detailed his session on effective PsA management.

Though it’s a homogenous disease without diagnostic subtypes, PsA may present in a number of ways, Smith said—necessitating a capacity to determine early signs and symptoms prior to disease progression.

“Persons may present with asymmetric joint involvement, upper and lower extremity at times, certainly,” Smith explained. “And others may present with symmetrical involvement, as we might think of with rheumatoid arthritis. Others present with more spinal or axial symptoms as well.”

The most commonly attributed PsA comorbidity is psoriasis, which generally affects about 3% of all White people; however, it is prevalent in skin of color as well, Smith said. Of those with psoriasis, approximately one-third will present with PsA.

“When we think about psoriatic arthritis, about 85% of the time, persons will present with the skin manifestations first, followed by the joint symptoms at some point in time,” Smith said. “Others may present with the joint symptoms first and then the skin, and then others may present simultaneously both skin and joint. And so, it's an interesting process in the way that that happens.”

Comorbidity care is among the most crucial aspects of PsA management, Smith said—an inflammatory-borne condition that could affect a patient’s cutaneous, cardiovascular and psychosocial health just as much as their psoriatic system. With regard to biologic therapy, Smith said comorbidities are a key guide for determine which treatment is right for which patient.

“And what's great now in 2024, we have multiple options that help us in making that decision to make a very patient-focused, patient-centered determination,” Smith said. “Shared decision making can also occur in this process as well, in terms of routing administration. And we talked about risks, benefits and expectations—you know, patients can really weigh in here as well.”


  1. Scotti L, Franchi M, Marchesoni A, Corrao G. Prevalence and incidence of psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2018;48(1):28-34. doi:10.1016/j.semarthrit.2018.01.003