TY - JOUR
T1 - A clinical review of structural damage in psoriatic arthritis for dermatologists
T2 - From pathogenesis to ongoing controversies
AU - Merola, Joseph F.
AU - Chakravarty, Soumya D.
AU - Choi, Olivia
AU - Chan, Daphne
AU - Gottlieb, Alice B.
N1 - Publisher Copyright:
© 2023 American Academy of Dermatology, Inc.
PY - 2024/2
Y1 - 2024/2
N2 - Psoriatic arthritis (PsA) is a chronic inflammatory disease that often goes unrecognized in patients with psoriasis. As a result, patients may develop significant structural damage before diagnosis and initiation of adequate treatment. Dermatologists are in an unique position to identify early signs and symptoms of PsA. Here, we briefly review the pathogenesis of PsA, differences in PsA presentation within real-world dermatology practice versus rheumatology clinical trials, and imaging modalities that can be used to assess structural damage. We then discuss several ongoing controversies related to prediction, assessment, and treatment of PsA-related structural damage. Debated questions include the following: (1) Does subclinical enthesitis predict progression from psoriasis to PsA?, (2) Does methotrexate inhibit progression of structural damage?, (3) Does structural damage correlate with clinical disease activity?, and (4) Can progression from psoriasis to PsA be prevented? Evidence presented herein suggests that dermatologists, together with rheumatologists, can play important roles in the early diagnosis and treatment of PsA, thereby potentially preventing irreversible structural damage.
AB - Psoriatic arthritis (PsA) is a chronic inflammatory disease that often goes unrecognized in patients with psoriasis. As a result, patients may develop significant structural damage before diagnosis and initiation of adequate treatment. Dermatologists are in an unique position to identify early signs and symptoms of PsA. Here, we briefly review the pathogenesis of PsA, differences in PsA presentation within real-world dermatology practice versus rheumatology clinical trials, and imaging modalities that can be used to assess structural damage. We then discuss several ongoing controversies related to prediction, assessment, and treatment of PsA-related structural damage. Debated questions include the following: (1) Does subclinical enthesitis predict progression from psoriasis to PsA?, (2) Does methotrexate inhibit progression of structural damage?, (3) Does structural damage correlate with clinical disease activity?, and (4) Can progression from psoriasis to PsA be prevented? Evidence presented herein suggests that dermatologists, together with rheumatologists, can play important roles in the early diagnosis and treatment of PsA, thereby potentially preventing irreversible structural damage.
KW - X-ray
KW - magnetic resonance imaging
KW - psoriasis
KW - psoriatic arthritis
KW - structural damage
KW - ultrasound
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U2 - 10.1016/j.jaad.2023.10.021
DO - 10.1016/j.jaad.2023.10.021
M3 - Review article
C2 - 37852305
AN - SCOPUS:85176384760
SN - 0190-9622
VL - 90
SP - 349
EP - 357
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 2
ER -