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  • Review Article
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The diagnosis and treatment of early psoriatic arthritis

Nature Reviews Rheumatology volume 5, pages 634–641 (2009)Cite this article

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder associated with a heterogeneous disease presentation, varied disease expression and an unpredictable but often chronically destructive clinical course. Joint damage can occur early in the disease; indeed, several imaging modalities have demonstrated subclinical joint involvement in psoriasis patients without musculoskeletal signs or symptoms. Efforts are underway to validate questionnaires that will enable dermatologists to screen patients with psoriasis for the presence of musculoskeletal disease. To date, the use of therapies in patients with early PsA has not been reported in randomized controlled trials. Moreover, conventional agents are partially effective in established PsA but, in general, trials with DMARDS have not included validated outcome measures for the different manifestations of PsA. Tumor necrosis factor antagonists can alleviate the signs and symptoms of established psoriatic arthritis and inhibit radiographic progression, but the therapeutic impact of early intervention with these agents requires further study. The extent of disease and the presence of comorbidities should be used to guide treatment decisions and to minimize adverse events.

Key Points

  • Psoriatic arthritis (PsA) follows a chronic, progressive course in the majority of patients, and joint damage occurs early in the disease course

  • Clinical trial data for the treatment of early PsA are not yet available, in sharp contrast to the high-level evidence published for therapy in early rheumatoid arthritis

  • Ultrasonography and MRI can identify subclinical joint disease in patients with psoriasis and can assist in the early diagnosis and assessment of joint damage in patients with PsA

  • Early treatment of PsA will probably suppress inflammation and alter the disease course, but evidence to support this statement is not yet forthcoming

  • The potential advantages of early therapy further underscore the need for early diagnosis but point to the need for prognostic markers that will help refine treatment stratification

  • Trials to demonstrate the efficacy of targeted biologic therapies and DMARDs for early PsA will test the validity of early intervention as a strategy to alter the disease course

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Figure 1: Imaging studies in early psoriatic arthritis.

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Acknowledgements

D. Lie, 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 MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Immunology & Rheumatology Research Division, Clinical Immunology Research Center, Allergy, University of Rochester Medical Center, Rochester, NY, USA

    Allen P. Anandarajah & Christopher T. Ritchlin

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Correspondence to Allen P. Anandarajah.

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Anandarajah, A., Ritchlin, C. The diagnosis and treatment of early psoriatic arthritis. Nat Rev Rheumatol 5, 634–641 (2009). https://doi.org/10.1038/nrrheum.2009.210

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