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  • Review Article
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Management of psoriatic arthritis from the view of the dermatologist

Nature Reviews Rheumatology volume 7, pages 588–598 (2011)Cite this article

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Abstract

Psoriatic arthritis (PsA) is an inflammatory seronegative spondyloarthropathy associated with psoriasis. Although the main assessment measures for PsA are borrowed from the standard criteria used to assess rheumatoid arthritis, a number of new criteria such as the PsAJAI and CPDAI are being developed specifically for PsA. Long-term consequences of untreated PsA include persistent inflammation, progressive joint damage and, in many cases, substantial functional limitations, pain and disability. Moreover, patients with PsA have an increased mortality risk and an increased risk of developing cardiovascular disease and metabolic syndrome. Both GRAPPA and the AAD have developed treatment guidelines, which are discussed here. Psoriasis commonly precedes arthritic symptoms; thus, dermatologists are ideally placed to make the initial diagnosis of PsA and treat it appropriately, affording the opportunity to slow disease progression, improve physical function and enhance quality of life. This Review explores the management of patients with PsA, with a particular emphasis on assessment tools, long-term consequences and treatment issues from the viewpoint of the dermatologist.

Key Points

  • Dermatologists are ideally placed to diagnose and treat psoriatic arthritis (PsA), as most patients present with skin symptoms before onset of arthritis

  • PsA is a potentially debilitating and destructive disease that should be treated as soon as possible after diagnosis to prevent irreversible damage

  • Patients with mild PsA can be managed with NSAIDs; however, systemic corticosteroids should be used cautiously in such cases

  • Moderate-to-severe cases of PsA can be managed by DMARDs or TNF inhibitors, administered either alone or in combination

  • Promising new drugs for the treatment of PsA include ustekinumab and abatacept

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Figure 1: Comparison of GRAPPA51 and AAD52 treatment guidelines for control of joint symptoms in PsA.

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Acknowledgements

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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  1. Department of Dermatology, Tufts Medical Center, 800 Washington Street, Boston, 02111, MA, USA

    Caroline A. Chang, Alice B. Gottlieb & Paul F. Lizzul

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C. A. Chang and A. B. Gottlieb contributed equally to researching data for the article, discussion of content, writing and review/editing of the manuscript before submission. P. Lizzul made a substantial contribution to discussion of the content and review/editing of the manuscript before submission.

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Correspondence to Alice B. Gottlieb.

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Competing interests

A. B. Gottlieb is on the Advisory Board for and is a recipient of honoraria from the following companies: Abbott Laboratories, Actelion, Amgen, Astellas Beiersdorf, Bristol Meyers Squibb Co., Celgene, Centocor Ortho Biotech, Cytokine PharmaSciences, Novo Nordisk, UCB. A. B. Gottlieb is a consultant for and is a recipient of honoraria from the following companies: Alnylam Pharmaceuticals, Amgen, BIND Biosciences, Can-Fite BioPharma, Celgene, Incyte, Merck, Ono Pharmaceutical, Pharmaceutical Product Development, Puretech, Schering-Plough. A. B. Gottlieb is an Investigator for and recipient of research grants and/or honoraria from the following companies: Abbott Laboratories, Amgen, Centocor Ortho Biotech, Immune Control, Novo Nordisk, UCB. A. B. Gottlieb has also received unspecified grants from Amgen and from Centocor Ortho Biotech, and unspecified honoraria from DermiPsor. P. F. Lizzul is an Investigator and grant recipient for Centocor Ortho Biotech, and is a Sub-investigator and grant recipient for Abbott Laboratories, Amgen, Immune Control and Novo Nordisk. C. A. Chang declares no competing interests.

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Chang, C., Gottlieb, A. & Lizzul, P. Management of psoriatic arthritis from the view of the dermatologist. Nat Rev Rheumatol 7, 588–598 (2011). https://doi.org/10.1038/nrrheum.2011.125

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