Structural Damage and Early Treatment Intervention from the Dermatologist’s Perspective

Dermatologists often play a critical role in the early identification of PsA, as many patients develop joint symptoms after years of receiving treatment for psoriasis. Although dermatologists historically deferred the diagnosis and management of PsA to rheumatologists, increasing awareness of the irreversible nature of joint damage has prompted a shift. Dermatologists now screen for early signs of arthritis more actively, especially in patients with high-risk features such as scalp or nail involvement or inverse psoriasis and those with a family history of PsA. Early detection is vital, as joint damage, unlike skin lesions, cannot be reversed and tends to worsen over time, making early treatment essential to prevent long-term disability.

Structural damage in PsA leads to functional impairment, and dermatologists are increasingly recognizing this risk. In rural or underserved areas, access to rheumatologists may be limited, prompting some dermatologists and primary care providers to initiate imaging or systemic therapy based on clinical suspicion. Predictors such as polyarticular involvement, dactylitis (diffuse swelling of an entire finger or toe), enthesitis (inflammation at tendon or ligament insertions), and high inflammatory markers are associated with more aggressive disease and increased risk for structural damage. Symptoms such as prolonged morning stiffness or subtle functional limitations (eg, difficulty with stairs, gripping, or buttoning) can be early signs of joint involvement, even if inflammation is not obvious on exam.

Additionally, evidence suggests that early systemic treatment for psoriasis—especially with certain biologics—may reduce the risk of PsA development. Dermatologists are beginning to consider this when choosing therapies, particularly for high-risk patients. Research also shows that achieving clear skin may correlate with a lower incidence of joint disease, suggesting that aggressive treatment of skin symptoms may indirectly benefit the joints. Overall, interdisciplinary collaboration and early, proactive intervention are key strategies for preventing structural damage and preserving long-term function in patients at risk for or newly developing PsA.