Elevating Psoriasis Care: The Role of IL-17 Inhibition in Advancing On-Treatment Remission - Episode 2
Screening Psoriasis Patients for Early Psoriatic Arthritis
Most psoriatic arthritis is preceded by psoriasis, which puts dermatologists on the front line of early detection. The panel details which patients warrant a closer look and how to screen efficiently.
This episode, "Screening Psoriasis Patients for Early Psoriatic Arthritis," turns to what a dermatologist should ask and look for when psoriasis walks through the door.
Dr. Wright starts with location, since most psoriatic arthritis is preceded by psoriasis. Where psoriasis sits changes the risk, so scalp involvement and skin folds raise concern. She then asks the simpler question: is the patient in front of her reporting joint pain or morning stiffness? She points to the PEST questionnaire, which patients can complete in the waiting room in seconds. A positive score should trigger a referral to someone who can manage it.
Dr. Wright acknowledges the flip side, which is access to rheumatology. Care deserts in rural and under-resourced areas can mean a 9-to-14-month wait, which is not early by any definition. She also raises skin of color, warning that clinicians trained only on lighter skin tones miss psoriasis entirely, so patients arrive already mislabeled with something else.
Dr. Han reviews the risk factors that have held up. Higher body surface area, roughly 75% or more or three distinct anatomical areas, is the most consistent signal. Obesity and nail psoriasis also track with psoriatic arthritis, with nail disease supported by the anatomical link between nail and joint. He is more skeptical of scalp psoriasis, since it is so prevalent, up to 80% in some ethnic groups, that it barely discriminates. He treats the severe, obese patient with nail disease as the clearest alarm bell.
Dr. Han endorses the PEST as a tool that actually saves time, sparing dermatologists the rabbit hole of open-ended joint questioning. Dr. Wright adds that a young patient whose joints have aged beyond their years should be an immediate red flag worth interrogating rather than accepting at face value.
In "Breaking Down Silos: Rheum-Derm Collaboration in Psoriasis Care," the panel steps back to ask how rheumatologists and dermatologists can actually work together, from combined clinics to simply picking up the phone.Welcome back to another HCPLive Peer Exchange series. In "Where Psoriasis and PsA Care Stand Today: Burden and Unmet Needs," moderator Saakshi Khattri, MD, FACR, FAAD is joined by George Han, MD, PhD and Grace Wright, MD, PhD, FACR to open the series on psoriatic disease.
