Psoriatic arthritis: state of the art review

Abstract

Psoriatic arthritis (PsA) accounts for around 20% of referrals to the early arthritis clinic and presents a signifi cant diagnostic and management challenge. Early diagnosis is important to prevent long term functional disability and to ensure optimal management of arthritis and key comorbidities. From the rheumatologist's perspective, the differential diagnosis includes rheumatoid arthritis, gout and other infl ammatory arthritides. Once diagnosed, it is essential to assess the disease fully, including arthritis, enthesitis, dactylitis, skin/ nail disease and axial involvement. Using this information, appropriate treatment can be planned using therapies that are effective at treating the relevant domains of disease. Despite poor data, traditional disease-modifying anti-rheumatic drugs are commonly used and have been effective in observational studies. Following tumour necrosis factor inhibitors, which have proven excellent effi cacy in multiple domains of PsA, new biologics are available or in development and will improve treatment options for people with refractory PsA. IntroductionIn 1964, psoriatic arthritis (PsA) was recognised as a separate disease by the American Rheumatism Association (now the American College of Rheumatology), and is now included as a member of the spondyloarthropathy spectrum.1 PsA was initially defined by Moll and Wright as 'an inflammatory arthritis in the presence of psoriasis with a usual absence of rheumatoid factor', 2 but newer more robust classification criteria are discussed in this article. Why is it important to recognise PsA?Although PsA was thought initially to be a relatively benign disorder, registry data has shown the destructive and progressive nature of the disease; 4 it has a similar impact on quality of life and functional ability as in rheumatoid arthritis. 5 ABSTRACT Psoriatic arthritis: state of the art reviewIn recent years, the additional burden of increased mortality and significant cardiovascular comorbidity has also been identified. 6 Despite this, identification and treatment are still not optimal. There are significant delays in diagnosis for the majority of patients (typically, in screening studies, up to 50% of established cases have not previously been identified).7 Delay in diagnoses of 6 and 12 months have been shown to impact on long-term joint damage and functional disability. 8,9 DiagnosisPsA is a heterogeneous condition with musculoskeletal involvement, including arthritis, enthesitis, dactylitis and axial involvement as well as potential skin and nail disease. Different patterns of involvement of PsA can mimic different inflammatory arthritides.For the rheumatologist, a patient presents with inflammatory arthritis and the differential diagnosis can include rheumatoid arthritis, crystal arthropathies and other inflammatory arthritides. When differentiating from rheumatoid arthritis, particularly in polyarticular PsA, there are a number of features Key pointsPsoriatic arthritis is an heterogeneous disease with multiple musculoskeletal and dermatol...

Complexities in Genetics of Psoriatic Arthritis

“…Interestingly, the five non-immune system genes whose variations are significantly associated with PsA (i.e., ANXA6, HSD3B7, KCNH7, P4HA2, TNIP1) are enriched in RAC1/PAK1/P38/MMP2, synthesis of bile acids/salts and prostaglandin, metabolism of bile acids, arginine and lipids, and biosynthesis of steroid and collagen pathways. These findings are supported through previous research that has linked many of these pathways with PsA and severe psoriasis cases [41][42][43][44].…”

RNAseq-Based Prioritization Revealed COL6A5, COL8A1, COL10A1 and MIR146A as Common and Differential Susceptibility Biomarkers for Psoriasis and Psoriatic Arthritis: Confirmation from Genotyping Analysis of 1417 Italian Subjects

“…Psoriatic skin lesions commonly appear on the scalp, elbows, knees, and lumbar area, and are responsible for itching, stinging and painful reactions [3]. The onset of PsA, instead, is generally characterized by arthritis, enthesitis, dactylitis and synovitis combined with the aforementioned psoriatic cutaneous manifestations [4,5].…”

Psoriatic Arthritis and Diabetes Mellitus: A Narrative Review

“…PsA develops in 8-36.4% of patients with psoriasis, equally in men and women in Europe and North America [4][5][6][7][8]. The clinical manifestations of PsA include peripheral arthritis, axial involvement, enthesitis, or dactylitis [9]. Patients with PsA could also present nail disease and more rarely uveitis [10].…”