Recent studies show that patients with psoriatic arthritis (PsA) have a higher risk of depression, with prevalence rates between 11.6% and 22.2%. Factors such as female gender, pain, fatigue, and high joint count are linked to depression and anxiety in patients with PsA. Biological mechanisms seen in other inflammatory diseases, like rheumatoid arthritis, may also contribute to depression in PsA. However, these studies lack comprehensive data on depression incidence or suicidal behaviors. This study, using the UK Clinical Practice Research Datalink, aimed to estimate rates of treated depression and suicidal behaviors in patients with PsA compared to those without PsA.

The study found that patients with PsA had a higher incidence of treated depression, especially among women and younger patients. Suicidal behaviors were similar across both groups, with no significant differences between patients with PsA and patients with non-PsA. Depression rates were higher in patients with PsA receiving systemic therapies, particularly immunosuppressants and corticosteroids. These results suggest that depression in treated patients with PsA may be linked to the severity of the disease, as those requiring treatment are more likely to have severe PsA. Overall, the study supports the connection between PsA and increased depression risk, with suicidal behaviors being similarly prevalent in both groups.

Reference: Hagberg KW, Li L, Peng M, et al. Incidence rates of suicidal behaviors and treated depression in patients with and without psoriatic arthritis using the Clinical Practice Research Datalink. Mod Rheumatol. 2016 Sep;26(5):774-9. doi: 10.3109/14397595.2015.1136726. Epub 2016 Feb 16. PMID: 26882216; PMCID: PMC5020333.

A population-based cohort study using the Rochester Epidemiology Project assessed the relationship between multimorbidity and the development of psoriatic arthritis (PsA) in patients with psoriasis. While newly diagnosed patients with psoriasis showed no significant difference in multimorbidity compared with matched controls, those with longstanding psoriasis had significantly higher rates of multiple chronic conditions. The presence of two or more chronic conditions at the time of psoriasis diagnosis was associated with a nearly threefold increased risk of developing PsA, especially among those with musculoskeletal or psychiatric comorbidities.

These findings suggest that patients with psoriasis may develop multimorbidity more rapidly than the general population, and that the presence of multiple chronic conditions at diagnosis could serve as an early signal for heightened PsA risk. Notably, multimorbidity was linked to PsA development regardless of psoriasis severity, reinforcing the need for vigilant monitoring across all patients psoriasis. The study highlights the importance of recognizing and managing comorbidities—particularly nonspecific musculoskeletal symptoms and mood disorders—as potential indicators of PsA risk, underscoring the need for integrated, proactive care strategies.

Reference: Karmacharya P, Chakradhar R, Hulshizer CA, et al. Multimorbidity in psoriasis as a risk factor for psoriatic arthritis: a population-based study. Rheumatology (Oxford). 2025 Apr 1;64(4):2199-2203. doi: 10.1093/rheumatology/keae040. PMID: 38291896; PMCID: PMC11962958.

A recent, large, real-world study compared early diagnostic and treatment outcomes for patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) using data from the UK’s National Early Inflammatory Arthritis Audit. Patients with PsA experienced longer delays in diagnosis—both before presenting to their general practitioner and after referral to secondary care—compared with matched patients with RA. Despite similar levels of disease activity at diagnosis, patients with PsA were significantly less likely to receive early or combination disease-modifying antirheumatic drug (DMARD) therapy and had smaller improvements in disease activity over 3 months. This delay and undertreatment led to worse short-term outcomes, even though most patients were enrolled in treat-to-target care pathways.

The study found that nearly 60% of PsA cases had polyarticular involvement, with fewer patients receiving corticosteroids and combination DMARD therapy compared to RA. Patient-reported outcome measures showed smaller improvements in musculoskeletal health and work productivity among patients with PsA. The findings underscore the critical need to improve awareness and early detection of PsA among patients and providers. Despite limitations—including underrepresentation of non-polyarticular PsA and the use of RA-centric outcome measures—the data suggest patients with PsA are systematically underdiagnosed and undertreated, reinforcing the need for more aggressive early management to improve long-term outcomes.

Reference: Charlton RA, Gates E, Coates LC, et al. Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set. Ann Rheum Dis. 2025 Jun;84(6):970-978. doi: 10.1016/j.ard.2025.02.020. Epub 2025 Mar 29. PMID: 40158947.

Researchers explored the role of gut microbiota in patients with psoriatic arthritis (PsA), particularly those presenting with enthesitis and dactylitis, compared to patients with undifferentiated arthritis lacking these features (NO PsA). Using 16S rRNA sequencing, researchers analyzed fecal samples from 9 patients with PsA and 10 patients with NO PsA, excluding those with other defined autoimmune diseases. While standard clinical lab tests could not distinguish between the groups, microbiome analysis revealed notable differences. Specifically, Megasphaera elsdenii was found at levels 10,000 times higher in PsA patients, while the family XIII_AD3011 was more prevalent in the NO PsA group.

The findings suggest that gut microbiota composition is more closely associated with the presence of enthesitis and dactylitis than conventional serum markers. Patients with PsA exhibited greater microbial homogeneity within the group and higher heterogeneity when compared to NO PsA patients. These microbial signatures, particularly Megasphaera elsdenii and Bifidobacterium longum (the latter showing a negative correlation with eosinophils), may serve as potential biomarkers for differentiating PsA from other forms of arthritis. A larger study with deeper biochemical analysis is recommended to validate these preliminary results and further explore the gut-joint axis in inflammatory arthritis.

Reference: Lin CY, Hsu CY, He HR, et al. Gut microbiota differences between psoriatic arthritis and other undifferentiated arthritis: A pilot study. Medicine (Baltimore). 2022 Jul 15;101(28):e29870. doi: 10.1097/MD.0000000000029870. PMID: 35839060; PMCID: PMC11132366.

This cross-sectional study evaluated whether ultrasonography could detect subclinical psoriatic arthritis (PsA) in patients with psoriasis who had no musculoskeletal complaints. Researchers examined lower limb entheses in 36 adults with psoriasis and 36 controls using the Glasgow Ultrasound Enthesitis Scoring System. Ultrasound identified inflammatory articular findings in 33 patients, and 26 patients met classification criteria for psoriatic arthritis (CASPAR) criteria for subclinical PsA because they also had psoriatic nail involvement. Common ultrasound findings included entheseal thickening, enthesophytes, and knee effusion.

The study found that quadriceps tendon thickness, enthesophytes, and bilateral quadriceps tendon thickening were more common in patients with subclinical PsA than in those without. Enthesophytes emerged as the strongest predictor of subclinical PsA in the analysis. The authors concluded that ultrasound may detect early inflammatory joint or entheseal changes that are not apparent on clinical examination. This could help identify patients with psoriasis who may be at higher risk for developing PsA and support earlier clinical consideration of joint involvement.

Reference: El-Sherif SM, Gaweesh T, Genedy RM. Diagnosis of subclinical psoriatic arthritis in patients with psoriasis using CASPAR criteria: a sonographic study. Egypt Rheumatol Rehabil. 2022 Nov 1;49:60. doi: 10.1186/s43166-022-00158-6.

Psoriatic arthritis (PsA) is an autoimmune disease often linked to psoriasis, where the immune system attacks the skin and joints. The condition causes joint pain, stiffness, and inflammation, and may also lead to skin rashes and changes in nails. PsA can manifest in different forms, such as distal interphalangeal predominant, symmetric polyarthritis, and spondylitis, affecting various joints. Around 30% of people with psoriasis will develop PsA, which is more common in those between 30 and 50 years of age. Although the exact cause of PsA is unknown, genetic mutations and family history are believed to play a role.

While there is no cure for PsA, treatments are available to manage symptoms and prevent progression. These include anti-inflammatory medications, disease-modifying drugs, physical therapy, and in rare cases, surgery. Regular visits to a healthcare provider are essential for managing the condition, especially if symptoms change or worsen. Patients with PsA also face higher risks of developing other health problems like cardiovascular disease, obesity, and diabetes. Early diagnosis and treatment are key to managing the disease and improving quality of life.

Reference: Health Library. Psoriatic Arthritis. Cleveland Clinic. Updated September 19, 2023. Accessed March 4, 2025. https://my.clevelandclinic.org/health/diseases/13286-psoriatic-arthritis

This literature evaluated the clinical, economic, and humanistic burden of psoriatic arthritis (PsA). The review focused on studies published between 1998 and 2009, which explored the direct and indirect costs of PsA, measures of clinical burden such as mortality, physical function, quality of life, productivity, and comorbid conditions. A total of 49 studies were reviewed, revealing that patients with PsA experience a significantly lower health-related quality of life and have a higher risk of comorbid conditions, particularly cardiovascular disease. In the United States, direct annual healthcare costs for PsA are estimated at up to $1.9 billion, with indirect costs accounting for 52% to 72% of total costs. Both direct and indirect costs increase as disease activity and physical function worsen.

The findings highlight the considerable economic and quality-of-life burden of PsA on both patients and society. The clinical burden of PsA, including comorbidities and disease activity, contributes to reduced physical and psychosocial health-related quality of life. These clinical aspects lead to higher direct medical costs due to increased healthcare utilization. Furthermore, the physical limitations caused by PsA contribute to substantial indirect costs, such as disability and lost productivity, making these factors significant drivers of the total cost of care for patients with PsA.

Reference: Lee S, Mendelsohn A, Sarnes E. The burden of psoriatic arthritis: a literature review from a global health systems perspective. P T. 2010 Dec;35(12):680-9. PMID: 21197266; PMCID: PMC3008384.

This review set out to summarize what’s known about psoriatic arthritis (PsA)—its epidemiology, how it’s diagnosed, and how it’s treated—while proposing a practical approach clinicians can use in everyday care. The authors screened MEDLINE for English-language papers published from January 2005 to October 2013 using PsA-focused terms, yielding 853 records. After exclusions and abstract review, 109 articles were included. They note that estimating PsA frequency remains challenging because diagnostic standards have varied over time, though the 2006 CASPAR criteria are highlighted as a more consistent framework for epidemiologic studies.

Across the included literature, PsA shows wide geographic variability in incidence and prevalence, with generally lower rates reported in Asia than in Europe and the Americas. Clinically, PsA is heterogeneous—ranging from peripheral arthritis, enthesitis, and dactylitis to axial disease and extra-articular features such as uveitis—so diagnosis relies on pattern recognition plus imaging (X-ray for classic destructive/proliferative changes; ultrasound and MRI for earlier or subclinical inflammation). Treatment goals focus on symptom relief, preserving function and joint structure, and addressing psychosocial needs: mild disease may start with NSAIDs and intra-articular steroids (systemic steroids discouraged), while moderate-to-severe disease often escalates to DMARDs and, when indicated, biologics (especially anti-TNF agents). The review also emphasizes earlier recognition and referral, particularly for patients with psoriasis who develop joint symptoms.

Reference: Liu JT, Yeh HM, Liu SY, Chen KT. Psoriatic arthritis: Epidemiology, diagnosis, and treatment. World J Orthop. 2014 Sep 18;5(4):537-43. doi: 10.5312/wjo.v5.i4.537. PMID: 25232529; PMCID: PMC4133459.

Psoriatic arthritis (PsA) is a systemic, chronic inflammatory arthritis commonly associated with psoriasis and typically seronegative for rheumatoid factor. Despite numerous published classification systems—including those by Moll and Wright, Bennett, Vasey and Espinoza, Fournié, the ESSG, and the CASPAR Study Group—the absence of a universally accepted criterion has complicated efforts in epidemiological research and treatment standardization. This study audited 69 patients with PsA to evaluate which of six commonly used classification criteria were most effective in clinical practice by comparing how many patients each set successfully identified.

Of the 60 patients included in the final analysis, only 35% met all six sets of criteria. The CASPAR criteria outperformed the others, identifying 89.7% of patients who did not meet all other sets—largely due to its inclusion of family history and allowance for rheumatoid factor-positive cases. In contrast, Bennett’s and Moll and Wright’s criteria had significantly lower sensitivity. The study concludes that the CASPAR criteria, with their broader scope and ease of use, have strong potential as the universal standard for PsA classification, although further validation studies are recommended.

Reference: Congi L, Roussou E. Clinical application of the CASPAR criteria for psoriatic arthritis compared to other existing criteria. Clin Exp Rheumatol. 2010 May-Jun;28(3):304-10. Epub 2010 Jun 23. PMID: 20576225.

Psoriatic arthritis (PsA) is an autoimmune disease that typically occurs alongside psoriasis, affecting the joints and potentially internal organs and the eyes. It shares symptoms with other diseases, making it difficult to diagnose. PsA affects individuals differently, but having access to resources, support, and information can help people manage the disease, whether they are newly diagnosed or have lived with it for years. The Arthritis Foundation provides educational materials, treatment options, and a community to help people with PsA navigate the challenges of the disease, manage their symptoms, and advocate for better care.

About 20% to 30% of people with psoriasis will develop psoriatic arthritis, which can also increase the risk of cardiovascular disease and other related health conditions. Early diagnosis and treatment are crucial to managing PsA, and various therapies are available to ease symptoms and slow disease progression. The Arthritis Foundation offers a range of resources, including treatment guidelines, self-care tips, and opportunities to connect with others through support groups and advocacy efforts. These resources help individuals manage PsA while improving their quality of life and increasing awareness of the disease.

Reference: Psoriatic Arthritis Patient Education & Resources. Arthritis Foundation. Accessed March 3, 2025. https://www.arthritis.org/psoriatic-arthritis-patient-education

Pro-inflammatory cytokines play a key role in the pathogenesis of rheumatoid arthritis (RA) and psoriatic arthritis (PsA), and their inhibition is effective in treating these conditions. JAK inhibitors, such as tofacitinib and baricitinib, target the JAK-STAT pathway and have proven efficacy in RA and PsA by affecting multiple cytokines involved in disease development and progression. In addition to their impact on inflammation, cytokines also influence pain and nociception, with increasing attention given to the JAK/STAT pathway's role in modulating nociceptive responses. Inhibition of this pathway using specific JAK inhibitors holds potential for alleviating pain in these diseases.

Clinical trials and real-world data demonstrate that JAK inhibitors, including tofacitinib and baricitinib, provide rapid pain relief in RA and PsA, suggesting a dual therapeutic role of these drugs in modulating both inflammation and nociception. This review explores the role of pain in rheumatic diseases, the physiological basis for modulating nociceptive pain, and how cytokines and the JAK/STAT pathway contribute to pain mediation. It also summarizes clinical data on the pain-modulating effects of JAK inhibitors in treating RA and PsA, highlighting their potential to improve clinical outcomes by reducing pain beyond the inflammatory component.

Reference: Crispino N, Ciccia F. JAK/STAT pathway and nociceptive cytokine signalling in rheumatoid arthritis and psoriatic arthritis. Clin Exp Rheumatol. 2021 May;39(3):668-675. doi: 10.55563/clinexprheumatol/e7ayu8. PMID: 33200731.

Psoriatic arthritis (PsA) is a complex inflammatory disease linked to psoriasis, often accompanied by comorbidities that impact prognosis and quality of life. Despite new drugs with strong efficacy and favorable safety profiles, managing PsA remains challenging, as some patients do not respond well to treatment. Recent research from 2022 to mid-2024 has focused on various aspects of PsA, including pathogenesis, diagnostic imaging, therapies, and comorbidities. Imaging techniques like ultrasound and MRI are crucial for diagnosing and monitoring PsA, detecting both inflammation and damage, and evaluating treatment effectiveness. Disease activity indices such as DAPSA and PASDAS are key for tracking PsA progression.

Patients with PsA often face comorbidities like cardiovascular disease, obesity, and depression, which worsen disease burden and quality of life. Factors like BMI and disease activity influence treatment outcomes, with obesity linked to lower chances of achieving minimal disease activity. New therapies, including TNF inhibitors, IL-17 inhibitors, and IL-23 inhibitors, have proven effective in managing PsA symptoms and improving quality of life. Drugs like secukinumab, ixekizumab, and bimekizumab have shown strong efficacy across PsA domains. Additionally, emerging artificial intelligence and machine learning models offer promising tools for enhancing diagnosis and personalizing treatment plans.

Reference: Esti L, Fattorini F, Cigolini C, et al. Clinical aspects of psoriatic arthritis: one year in review 2024. Clin Exp Rheumatol. 2025 Jan;43(1):4-13. doi: 10.55563/clinexprheumatol/7gug1a. Epub 2025 Jan 23. PMID: 39846367.

Psoriatic arthritis (PsA) is a complex disease that presents in various ways, making its diagnosis and management challenging. Imaging plays a vital role in distinguishing between axial and peripheral PsA and identifying extra-articular involvement like enthesitis and dactylitis. Early diagnosis is key for better clinical outcomes, and selecting the right imaging techniques—such as MRI, ultrasonography (US), and conventional radiography —helps assess disease activity, structural changes, and inflammation. Advanced imaging methods like high-resolution peripheral computed tomography and dual-energy computed tomography offer more precise evaluations of PsA.

The heterogeneity of PsA makes accurate diagnosis challenging for rheumatologists. Imaging methods like MRI and US are increasingly relied upon to detect inflammation and structural damage, even in asymptomatic patients. Novel techniques like DECT and fluorescence optical imaging are being explored to improve diagnostic accuracy and monitor disease progression, especially in the early stages. These advancements are expected to lead to more precise diagnoses and personalized treatment strategies, enhancing PsA management.

Reference: Fassio A, Matzneller P, Idolazzi L. Recent Advances in Imaging for Diagnosis, Monitoring, and Prognosis of Psoriatic Arthritis. Front Med (Lausanne). 2020 Oct 29;7:551684. doi: 10.3389/fmed.2020.551684. PMID: 33195301; PMCID: PMC7658536.

Since the 1990s—especially after the 2015 US Precision Medicine Initiative—precision medicine focused on stratifying patients by molecular profiles to match them with targeted therapies. This is particularly relevant to heterogeneous autoimmune diseases such as PsA, SLE, RA, IgG4-RD, and ANCA-associated vasculitis, where “one-size-fits-all” treatment is often inefficient. Peripheral immune cell phenotyping has emerged as a practical way to stratify patients when biopsies are hard to obtain, defining immunologic subgroups and linking them to disease activity and treatment response. Supported by mass cytometry and multi-omics, these approaches are starting to map the cellular and molecular heterogeneity driving autoimmune disease.

Psoriatic arthritis illustrates how this can work in practice. In a real-world study, patients were grouped into Th17-dominant, Th1-dominant, mixed Th1/Th17-high, or Th1/Th17-low patterns and then treated with ustekinumab, IL-17 inhibitors, or TNF inhibitors according to their T-helper phenotype. This “strategic bDMARD” approach produced more patients with low disease activity than standard TNF-first treatment, suggesting phenotype-guided therapy can improve outcomes. However, correlations with clinical severity were modest, the methods are complex, and newer agents and additional cell subsets still need to be incorporated. Combining peripheral phenotyping with tissue or liquid biopsies, serum cytokines, and longitudinal single-cell multi-omics may ultimately enable mature precision medicine in PsA and other autoimmune diseases.

Reference: Miyagawa I, Tanaka Y. Dawn of Precision Medicine in Psoriatic Arthritis. Front Med (Lausanne). 2022 Mar 18;9:851892. doi: 10.3389/fmed.2022.851892. PMID: 35372404; PMCID: PMC8973395.

This observational study evaluated the long-term clinical outcomes of adalimumab (ADA), etanercept (ETN), and infliximab (IFX) in biologic-naive patients with psoriatic arthritis (PsA) who began treatment with these drugs. The study included 420 patients and used Kaplan-Meier analysis to assess drug survival, with Cox regression analysis identifying baseline predictors of drug discontinuation. The frequency and dosage of concomitant glucocorticoids were also tracked over a four-year period. Results showed that ETN had the highest drug survival rate (58.9%) compared to ADA (43.9%) and IFX (44.0%), with a significant difference observed (p = 0.003). Female sex and disease duration were key predictors of drug discontinuation.

Over the four years, the average daily prednisone dose significantly decreased, from 5.6 ± 2.5 at baseline to 4.0 ± 1.8 by year 4 (p = 0.001). Additionally, the proportion of patients taking glucocorticoids dropped from 49.6% at baseline to 22.6% by year 4 (p < 0.01). The findings indicate that in real-world settings, TNF inhibitors like ETN, ADA, and IFX are effective for long-term management of PsA, with lower reliance on glucocorticoids over time.

Reference: Iannone F, Lopriore S, Bucci R, et al. Longterm Clinical Outcomes in 420 Patients with Psoriatic Arthritis Taking Anti-tumor Necrosis Factor Drugs in Real-world Settings. J Rheumatol. 2016 May;43(5):911-7. doi: 10.3899/jrheum.151042. Epub 2016 Mar 15. PMID: 26980583.

Phosphodiesterases (PDEs) are enzymes that degrade the second messengers cAMP and cGMP, influencing processes like cell proliferation, apoptosis, inflammation, and immune response. With 11 isoenzyme groups and 50 isoforms, PDEs regulate intracellular signaling and are involved in diseases such as COPD, depression, diabetes, and inflammatory conditions like inflammatory bowel diseases (IBD) and psoriatic arthritis (PsA). IBD and PsA share immune dysregulation and the IL-23/IL-17 axis, often overlapping with enteropathic spondyloarthritis (eSpA), which connects gut and joint diseases. This has led to multidisciplinary approaches to improve diagnosis and treatment.

Apremilast, an oral PDE4 inhibitor, effectively treats PsA by modulating inflammatory mediators like TNF, IL-17, and IFN-γ, while promoting regulatory cytokines like IL-10. It has a good safety profile in clinical trials and real-life settings. Apremilast has also shown clinical and endoscopic improvements in patients with ulcerative colitis, though clinical remission was not fully achieved. In PsA, it significantly improved disease markers such as ACR20, ACR50, and ACR70, with long-term benefits. Apremilast has also been effective in treating skin manifestations and extra-articular symptoms like enthesitis and dactylitis in PsA, making it a valuable option for managing both PsA and eSpA.

Reference: Picchianti-Diamanti A, Spinelli FR, Rosado MM, Conti F, Laganà B. Inhibition of Phosphodiesterase-4 in Psoriatic Arthritis and Inflammatory Bowel Diseases. Int J Mol Sci. 2021 Mar 5;22(5):2638. doi: 10.3390/ijms22052638. PMID: 33807944; PMCID: PMC7961737.

The IL-17 family includes cytokines involved in both acute and chronic inflammatory responses. Since IL-17A was identified in 1993, five other members (IL-17B to IL-17F) have been discovered, with IL-17A and IL-17F being the most closely related. These cytokines generally function as homodimers, except for IL-17A and IL-17F, which can form heterodimers. Their signaling requires a receptor complex of IL-17RA and IL-17RC, activating inflammation via NF-κB and MAPK pathways. IL-17A plays a key role in autoimmune and chronic inflammatory diseases, with therapies targeting IL-17 effective in conditions like psoriasis, psoriatic arthritis, and ankylosing spondylitis (axSpA). Both IL-17A and IL-17F are produced by various immune cells, including Th17 cells, stimulating inflammatory mediators such as TNF, IL-1, and IL-6.

Targeting IL-17A and IL-17F has shown efficacy in several immune-mediated inflammatory diseases, though responses vary. Blocking IL-17A is effective for psoriasis, psoriatic arthritis, and axSpA, but less so in inflammatory bowel disease. While IL-17F is less potent than IL-17A, it still contributes to inflammation, and dual blockade of both cytokines has proven more effective in suppressing inflammatory mediators. Bimekizumab, a dual IL-17A/F inhibitor, has shown superior efficacy in treating psoriasis and psoriatic arthritis, with benefits in axSpA. Other therapies, like sonelokimab, are also under investigation. Dual cytokine inhibition may offer more comprehensive disease control than targeting IL-17A alone.

Reference: Sánchez-Rodríguez G, Puig L. Pathogenic Role of IL-17 and Therapeutic Targeting of IL-17F in Psoriatic Arthritis and Spondyloarthropathies. Int J Mol Sci. 2023 Jun 18;24(12):10305. doi: 10.3390/ijms241210305. PMID: 37373452; PMCID: PMC10299014.

The review argues that early psoriatic arthritis (ePsA) likely begins years before formal diagnosis and often progresses through identifiable preclinical stages in people with psoriasis, including increased-risk patients, those with silent imaging abnormalities, and those with unexplained musculoskeletal symptoms. Key risk factors include nail, scalp, and genital psoriasis, obesity, arthralgia, severe skin disease, uveitis, family history, and certain HLA genes. Because many patients with psoriasis may already have subclinical joint or entheseal inflammation, the authors emphasize the importance of early recognition through screening questionnaires, imaging, and clinical vigilance. Tools such as PASE, PEST, EARP, ToPAS, and STRIPP can help flag possible PsA. Imaging modalities such as ultrasound and MRI are often more sensitive than physical exam for detecting early inflammatory changes.

The article also highlights that, despite progress, there is still no gold-standard biomarker or single diagnostic method for ePsA, making early diagnosis and treatment decisions challenging. Management is guided largely by current disease severity and may begin with NSAIDs or conventional DMARDs such as methotrexate or leflunomide, with biologics or JAK inhibitors used when needed, especially in more active or resistant disease. The authors note that early intervention may help reduce progression and structural damage, but not all patients follow the same course, so overtreatment remains a concern. Current guidelines from groups such as GRAPPA, EULAR, and ACR/NPF differ somewhat, especially around first-line use of biologics, partly because of cost and healthcare system differences. Overall, the review concludes that better biomarkers, standardized imaging protocols, and stronger evidence are still needed to identify which patients will benefit most from early treatment.

Reference: Hioki T, Komine M, Ohtsuki M. Diagnosis and Intervention in Early Psoriatic Arthritis. J Clin Med. 2022 Apr 6;11(7):2051. doi: 10.3390/jcm11072051. PMID: 35407659; PMCID: PMC8999837.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with environmental, hormonal, and genetic contributors. It can overlap with other connective tissue disorders, and rare coexistence with psoriasis (Ps) and psoriatic arthritis (PsA) has been reported. Because clinical features may mimic each other (eg, subacute cutaneous lupus vs Ps) and anti-TNF therapy for PsA can precipitate lupus-like syndromes in a small fraction of patients, the authors retrospectively reviewed patients with SLE seen at a tertiary academic rheumatology clinic (1990-2012). SLE was defined by the 1997 American College of Rheumatology criteria; Ps was diagnosed clinically; PsA met CASPAR criteria. Demographics, labs, and radiology were abstracted, and group comparisons used chi-square tests (p<0.05).

Among 445 patients with SLE, 23 (5.1%) had psoriasis and 20 (4.5%) had PsA. Notably, 20 of 23 SLE+Ps patients (87%) also had PsA. Compared with SLE without Ps/PsA, those with concomitant Ps or PsA had higher frequencies of malar rash, discoid rash, photosensitivity, and arthritis, while antiphospholipid antibodies were less common. No significant differences were seen for neuropsychiatric, serosal, renal, hematologic features, anti-Sm, or anti-DNA antibodies. The findings underscore that although coexistence is uncommon, clinicians should maintain diagnostic vigilance and tailor management given overlapping cutaneous features and potential therapy-related lupus phenomena.

Reference: Bonilla E, Shadakshari A, Perl A. Association of psoriasis and psoriatic arthritis with systemic lupus erythematosus. Rheumatol Orthop Med. 2016;1. doi:10.15761/ROM.1000105.

Psoriasis is associated with psychiatric comorbidities, but the connection between psoriasis and suicidality has not been fully understood. A systematic review and meta-analysis were conducted to explore this relationship, examining literature from 1946 to 2017 across multiple databases. The study included 18 studies with a total of 1,767,583 participants, 330,207 of whom had psoriasis. The analysis found that patients with psoriasis had a significantly higher risk of suicidal ideation (odds ratio [OR] 2.05) and suicidality (attempted and completed suicides, OR 1.26), with younger age and more severe psoriasis associated with an even higher likelihood of suicidality.

The findings suggest that individuals with psoriasis are at increased risk for suicidal thoughts, attempts, and completions. Subgroup analysis revealed that patients with more severe psoriasis were more likely to attempt suicide (OR 1.32) and complete suicide (OR 1.20). However, the study also noted a lack of research specifically focusing on the severity of psoriasis in relation to suicidality. Overall, the study highlights the need for increased attention to the mental health of patients with psoriasis, especially those who are younger or have more severe forms of the disease.

Reference: Singh S, Taylor C, Kornmehl H, et al. Psoriasis and suicidality: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Sep;77(3):425-440.e2. doi: 10.1016/j.jaad.2017.05.019. PMID: 28807109.

The objective of this study was to develop comprehensive treatment recommendations for the various clinical manifestations of psoriatic arthritis (PsA), drawing from evidence gathered through a systematic literature review and consensus opinion. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) conducted formal reviews of treatment for key PsA manifestations, including skin and nails, peripheral arthritis, axial disease, dactylitis, and enthesitis. Based on these reviews, treatment recommendations were drafted by a group of rheumatologists, dermatologists, and patients with PsA. An online questionnaire was used to assess the level of agreement among GRAPPA members regarding these recommendations.

The study resulted in 19 treatment recommendations for managing peripheral arthritis, axial disease, psoriasis, nail disease, dactylitis, and enthesitis in patients with PsA. A consensus of over 80% agreement was reached on 16 of these recommendations. Additionally, a grid was created to help clinicians incorporate disease severity into treatment decisions for individual patients, offering an evidence-based approach. The recommendations were developed through collaboration between rheumatologists and dermatologists, with plans for periodic updates as new data emerge.

Reference: Ritchlin CT, Kavanaugh A, Gladman DD, et al. Treatment recommendations for psoriatic arthritis. Ann Rheum Dis. 2009 Sep;68(9):1387-94. doi: 10.1136/ard.2008.094946. PMID: 19255284.