Psoriatic Arthritis

Spotlight article

CRP and ESR Don’t Always Agree

This large retrospective rheumatology laboratory study analyzed C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) patterns from more than 16,000 patients and over 44,000 same-day CRP/ESR pairs between 2018 and 2023. The goal was to understand how these two inflammatory markers behave across rheumatic diagnoses and how often they agree or diverge in routine care. CRP was more disease-discriminative and only weakly related to age, while ESR was more age-dependent and showed stronger sex-related differences. Inflammatory burden was highest in gout and rheumatoid arthritis, intermediate in psoriatic arthritis (PsA) and ankylosing spondylitis, and generally lower in connective tissue diseases and osteoarthritis.

 

CRP and ESR were moderately correlated overall, but they were not interchangeable. About 45% of same-day pairs were both normal, 27% were both abnormal, and another 27% were discordant, meaning only one marker was elevated. Dual-positive patterns were most common in inflammatory arthritides such as  rheumatoid arthritis, PsA, ankylosing spondylitis, and gout, while osteoarthritis was mostly dual-negative. Connective tissue diseases, especially systemic lupus erythematosus and systemic sclerosis, were more likely to show ESR-only elevation. The authors conclude that CRP and ESR should be interpreted as complementary markers, with discordance viewed as a common, diagnosis-patterned finding rather than random noise.

 

Reference: Popescu CC, Enache L, Ștențel C, Mogoșan C, Codreanu C. Real-World Distributions and Concordance of C-Reactive Protein and Erythrocyte Sedimentation Rate Across Rheumatic Diseases. Clin Pract. 2026 Apr 13;16(4):72. doi: 10.3390/clinpract16040072. PMID: 42041949; PMCID: PMC13114268.

Kori Dewing

ANP-BC, ARNP, DNP

Teaching Associate, University of Washington, Department of Medicine, Division of Rheumatology

Featured article

Psoriasis and Sunlight: Help or Harm?

This article explains that sunlight can sometimes help improve psoriasis symptoms because UVB rays slow rapid skin-cell turnover and may reduce inflammation. Many people with psoriasis notice their plaques improve during summer or in sunnier climates, and medical phototherapy uses controlled UV light as an established psoriasis treatment. However, not all sunlight is beneficial: UVA rays penetrate deeper into the skin and contribute to tanning, aging, and skin damage, and tanning beds are not recommended because they primarily use UVA light.

 

The article emphasizes that sun exposure should be gradual, limited, and protected with broad-spectrum sunscreen, ideally SPF 30 or higher, fragrance-free, and suitable for sensitive skin. Too much sun can worsen psoriasis and increase the risk of burns and skin cancer, so patients should talk with their physician, especially if they are already receiving phototherapy or have severe psoriasis. Sunlight also may offer general health benefits, including improved mood, sleep, stress reduction, and vitamin D production, but it should be used carefully as part of a broader psoriasis management plan.

 

Reference: Shah B. Psoriasis and the sun - helpful or harmful? American College of Rheumatology. Published August 17, 2023. Accessed July 9, 2026. https://rheumatology.org/patient-blog/psoriasis-and-the-sun-helpful-or-harmful

Tiffany Terrell

APRN, FNP-C

Pediatric Psoriasis: Watch for PsA

This prospective registry study followed 717 pediatric patients with plaque psoriasis in the ChildCAPTURE registry to assess how often juvenile psoriatic arthritis (JPsA) or psoriatic arthritis (PsA) developed during childhood or young adulthood. Overall, 15 patients, or 2.1%, developed JPsA/PsA, with eight diagnosed before age 18 and seven diagnosed between ages 18 and 30. The estimated cumulative incidence was 2.8% within 10 years after pediatric psoriasis onset. Median age at psoriasis diagnosis among those who developed arthritis was 12.0 years, median age at arthritis diagnosis was 17.3 years. The median time from psoriasis onset to arthritis diagnosis was 4.8 years.

 

Patients who developed JPsA/PsA were more often male, more likely to have obesity, and more likely to have nail involvement compared with the overall pediatric psoriasis cohort. At arthritis diagnosis, 58.3% were overweight or obese, and 50% had nail involvement. Notably, several patients developed arthritis despite being on systemic or biologic therapy. Psoriasis severity was often lower at the time of arthritis diagnosis than at registry inclusion, suggesting that JPsA/PsA can emerge even when skin disease appears clinically controlled. The authors conclude that while arthritis development in pediatric psoriasis is relatively uncommon, clinicians should stay alert for joint symptoms, especially in patients with higher BMI, nail involvement, and later-onset pediatric psoriasis.

 

Reference: Al-Gawahiri M, de Jong EMGJ, Schatorjé EJH, et al. Development of Arthritis in a Large Real-World Cohort of Patients With Pediatric Onset Psoriasis. J Psoriasis Psoriatic Arthritis. 2026 Apr 25:24755303261446205. doi: 10.1177/24755303261446205. Epub ahead of print. PMID: 42046717; PMCID: PMC13110248.

Kori Dewing

ANP-BC, ARNP, DNP

Long-Term PsA Control: 244-Week Data

The KEEPsAKE 1 poster reports long-term efficacy and safety data for risankizumab in biologic-naïve adults with active psoriatic arthritis (PsA) who had an inadequate response or intolerance to conventional synthetic DMARDs. After a 24-week double-blind placebo-controlled period, patients entered an open-label extension and received risankizumab 150 mg every 12 weeks, with outcomes reported through Week 244. Long-term treatment was associated with durable improvements across PsA domains, including ACR20/50/70 responses, resolution of enthesitis and dactylitis, minimal disease activity, PASI90, pain, nail psoriasis measures, physical function, fatigue, and quality-of-life measures. Radiographic endpoints were collected through Week 244, with low rates of radiographic progression reported.

 

Safety findings remained generally consistent with prior risankizumab studies, with no new safety signals identified through 244 weeks. Treatment-emergent adverse event rates, serious adverse event rates, and discontinuations due to adverse events remained stable over long-term follow-up. However, interpretation should account for important limitations: the open-label extension may enrich the remaining population because patients who do not respond or tolerate treatment may discontinue, and “as observed” analyses exclude patients with missing data at specific time points, which can increase apparent response rates. The poster also notes that some radiographic and ACR endpoints were not ranked or adjusted for multiplicity, so certain statistical or clinical conclusions should be interpreted cautiously.

 

Reference: Keiserman M, Papp K, White D, et al. Long-term efficacy and safety of an IL-23i through ~5 years in PsA (KEEPsAKE 1). RheumNow. Approved March 2026. Accessed July 9, 2026. https://rheumnow.com/video-poster/long-term-efficacy-and-safety-il-23i-through-5-years-psa-keepsake-1

Tiffany Terrell

APRN, FNP-C

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