Targeting Structural Damage in Psoriatic Arthritis: The Impact of Early Recognition and Timely Intervention - Episode 2
Providing Patient-Centered Care in Psoriatic Arthritis
Experts discuss the profound impact of unchecked structural damage in psoriatic arthritis (PsA) on long-term physical function and quality of life, highlighting the predictive value of early joint damage, the importance of aligning treatment with individual functional goals, and the critical need for early detection—including of silent disease—through advanced imaging or regular monitoring.
If structural damage in PsA is not prevented, it leads to significant and often irreversible declines in physical function. Data from studies such as the subanalysis of the GO-REVEAL trial have shown a strong correlation between structural damage—measured via joint space narrowing and bone erosion—and a patient’s functional ability, as assessed by the Health Assessment Questionnaire Disability Index (HAQ-DI). In fact, early joint damage scores can predict future functional decline, reinforcing the idea that joint destruction has long-term, irreversible consequences. Although patients may tolerate pain and fatigue, their primary concern often lies in preserving function, such as being able to perform everyday activities or maintain important roles such as playing with grandchildren in the future.
The burden of unaddressed structural damage manifests in significant quality of life impairments. The HAQ-DI captures this by evaluating daily tasks such as dressing, eating, walking, and climbing stairs. For some patients, even simple tasks such as buttoning a shirt or lifting a glass become unmanageable. This disability can be deeply validating or distressing, depending on the individual’s progression. The emotional and practical impact is profound, as patients may lose the ability to engage in hobbies, work, or meaningful family interactions. Understanding what each patient values—whether it is running marathons or gardening—is essential, so treatment plans can be aligned with preserving those specific capabilities.
Additionally, silent or subclinical joint damage can occur without obvious symptoms such as pain or swelling. This makes early detection especially challenging but crucial. Advanced imaging tools such as ultrasound can reveal inflammation and erosive changes before patients are aware of any loss of function. Where ultrasound is unavailable, serial x-rays every 2 to 5 years are a reasonable alternative to monitor for hidden disease progression. Preventing this silent damage through early intervention is key to avoiding long-term disability and maintaining a high quality of life.
