Elevating Psoriasis Care: The Role of IL-17 Inhibition in Advancing On-Treatment Remission - Episode 1
Where Psoriasis and PsA Care Stand Today: Burden and Unmet Needs
Plaque psoriasis has reached total clearance for many patients, yet psoriatic arthritis still lags behind. The panel opens by mapping where the two halves of psoriatic disease diverge.
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.
Dr. Han argues that psoriasis looks like a success story from the outside. Twelve biologics are approved for plaque psoriasis, with oral options and several agents for psoriatic arthritis. He notes that 100% skin clearance is now the envy of every other disease state in dermatology. But he pushes past the headline numbers to the gaps that remain.
Dr. Han flags patients who cycle through therapies with secondary loss of response, a problem we still cannot explain mechanistically. He then turns to access. Specialists cluster in cities, and he jokes that New York has a dermatologist on every corner alongside a Starbucks. Yet some patients drive five hours to reach a dermatologist who has never prescribed advanced systemic therapy. His last point is that psoriatic arthritis lags well behind the skin, with joint progression continuing even on effective treatment.
Dr. Khattri picks up that thread, contrasting PASI 100 on the skin with the field only recently moving from ACR20 to ACR50 in the joints. Dr. Wright says her envy of PASI 100 tells the whole story. There is no ACR100, and psoriatic arthritis involves many tissue types at once.
Dr. Wright explains that synovitis, dactylitis, and enthesitis must all resolve for a patient to feel their skeleton simply works. That makes the bar harder to clear than skin alone. She stresses the diagnostic delay, which runs five to ten years depending on the country, so damage may already be set by the time a patient reports joint pain. She also reminds the panel that some patients start with joints rather than skin, and warns against dismissing inflammatory arthritis as osteoarthritis, which forfeits the chance to manage both together.
The next episode in this series, "Screening Psoriasis Patients for Early Psoriatic Arthritis," features Dr. Wright and Dr. Han on how dermatologists can catch psoriatic arthritis earlier, including the role of the PEST screening tool.
