This patient-facing American College of Rheumatology resource focuses on pregnancy planning for women with psoriatic arthritis. It emphasizes that the safest pregnancy planning approach includes keeping psoriatic arthritis disease activity as low as possible, reviewing medications with the care team, and using pregnancy-compatible “green list” medications when appropriate. Well-controlled disease is described as minimal skin, nail, and joint inflammation; no recent symptoms suggestive of iritis, inflammatory bowel disease, enthesitis, or dactylitis; and no flares in the past 6 months.

The resource encourages patients to discuss medications with their rheumatology or dermatology provider, maternal-fetal medicine specialist, local OB, and dermatologist. Medications are grouped into green, grey, and red categories: some are considered generally compatible, others require discussion with a rheumatologist, and others should be stopped before pregnancy. It specifically flags methotrexate and leflunomide as red-list medications, while noting that NSAIDs may be used in the first trimester but should be discussed with the rheumatologist, especially regarding discontinuation around 20 weeks of gestation.

Reference: American College of Rheumatology. Pregnancy planning for women with psoriatic arthritis. American College of Rheumatology Reproductive Health Initiative. Published 2021. Accessed June 2, 2026. DOI not available; PMID not available; PMCID not available.

This cross-sectional study assessed disease burden, functional status, quality of life, and depressive symptoms in 300 patients with psoriatic disease, including 111 with psoriasis and 189 with psoriatic arthritis (PsA). Patients with PsA had significantly worse functional capacity than those with psoriasis alone, with 19% showing clinically significant functional impairment compared with 1.8% of patients with psoriasis. PsA diagnosis, depressive symptoms, and older age were independently associated with functional impairment.

Depressive symptoms were common and appeared underdiagnosed. At least mild depressive symptoms were reported by 54% of patients with psoriasis and 69% of patients with PsA, while moderate-to-severe symptoms were reported by 19.8% and 30.1%, respectively. Functional impairment, axial complaints, PsA diagnosis, and the number of painful joint regions were independently associated with depressive symptoms. The authors emphasized the need for early recognition of PsA, attention to patient-reported burden, and improved screening for depression in patients with psoriatic disease.

Reference: Frede N, Hiestand S, Schauer F, et al. Psoriasis and Psoriatic Arthritis Have a Major Impact on Quality of Life and Depressive Symptoms: A Cross-Sectional Study of 300 Patients. Rheumatol Ther. 2023 Dec;10(6):1655-1668. doi: 10.1007/s40744-023-00602-9. Epub 2023 Oct 15. PMID: 37843747; PMCID: PMC10654309.

This systematic review and meta-analysis evaluated all-cause mortality in patients with psoriatic arthritis (PsA) by pooling data from 20 observational studies involving more than 130,000 patients. Overall, patients with PsA had a modest but statistically significant increase in mortality compared with the general population. The increased risk appeared more pronounced in female patients and in studies from Asian countries. However, the authors noted substantial heterogeneity across studies and urged cautious interpretation.

The most commonly reported causes of death were malignancy, cardiovascular and cerebrovascular disease, and infection or respiratory disease. Potential mortality risk factors included older age, male sex, elevated inflammatory markers, and comorbidities, although available data were limited and could not support a full meta-analysis of predictors. The authors concluded that PsA is associated with increased mortality risk and emphasized the importance of broader risk assessment in clinical care, including attention to cardiovascular health, cancer screening, infection risk, and comorbidity management.

Reference: Huang H, Xie W, Geng Y, Fan Y, Zhang Z. Mortality in patients with psoriatic arthritis: a systematic review and meta-analysis. Front Immunol. 2025 Aug 18;16:1622159. doi: 10.3389/fimmu.2025.1622159. PMID: 40901477; PMCID: PMC12399637.

Psoriasis is increasingly understood as a systemic inflammatory disease that is linked to a higher risk of nonalcoholic fatty liver disease (NAFLD), with patients who have both conditions often experiencing more severe psoriasis and greater risk of liver fibrosis. NAFLD ranges from simple fatty liver to nonalcoholic steatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and even liver cancer. Because many patients are asymptomatic, NAFLD is often identified through mildly abnormal liver tests or imaging such as ultrasound, CT, or MRI. Liver biopsy remains the only way to distinguish simple fatty liver from NASH. The review highlights that patients with psoriasis are significantly more likely than controls to have NAFLD. This association appears to persist even after accounting for shared metabolic risk factors such as obesity and metabolic syndrome.

The article also stresses that recognizing NAFLD in patients with psoriasis matters because it can influence both broader health risk assessment and treatment selection. Lifestyle measures such as weight loss, exercise, reducing alcohol intake, and limiting saturated fats and high-fructose corn syrup may help improve liver health. Supplements such as vitamin D, vitamin E, and omega-3 fatty acids may offer some benefit in selected patients. Some early evidence suggests TNF-alpha inhibitors may improve liver-related markers, but larger studies are still needed. At the same time, certain psoriasis treatments, especially methotrexate, and potentially cyclosporine or acitretin, may worsen liver-related risks and should be used carefully in patients with NAFLD. Overall, the review argues that screening for fatty liver disease and tailoring psoriasis treatment accordingly may help reduce both hepatic and cardiometabolic complications.

Reference: Prussick R, Prussick L, Nussbaum D. Nonalcoholic Fatty liver disease and psoriasis: what a dermatologist needs to know. J Clin Aesthet Dermatol. 2015 Mar;8(3):43-5. PMID: 25852814; PMCID: PMC4382145.

Obesity is common in psoriatic arthritis (PsA), affecting up to 48% of patients, and appears to worsen disease burden through both inflammatory and mechanical pathways. This article explains that excess adipose tissue promotes low-grade systemic inflammation and releases proinflammatory mediators that may contribute to PsA pathogenesis. Added joint stress may further drive symptoms. In turn, functional limitations from PsA can reduce physical activity and contribute to additional weight gain. Clinically, obesity is associated with higher disease activity, multidrug treatment failure, and lower odds of reaching minimal disease activity (MDA), which may help explain why many patients do not meet treatment goals even after TNF inhibitor therapy.

The article also emphasizes that weight management is a modifiable factor that may improve outcomes in patients with active PsA and obesity. Current recommendations from GRAPPA, ACR, and EULAR support addressing obesity as part of PsA management, using approaches such as nutrition, exercise, behavioral support, pharmacotherapy, or bariatric surgery. Evidence cited includes studies showing that diet-based weight loss, especially at least 5% body weight reduction, is associated with higher likelihood of achieving MDA and with improvements in disease activity, pain, fatigue, and related outcomes. Overall, the message is that proactive attention to weight may help clinicians improve disease control and reduce the overall impact of PsA.

Reference: Lilly Medical Affairs. The Impact of Obesity on Psoriatic Arthritis. RheumNow. Published February 1, 2026. Accessed March 30, 2026.

In this study, researchers examined the long-term clinical course and outcomes of juvenile psoriatic arthritis (JPsA), a juvenile idiopathic arthritis (JIA) category more clearly recognized after adoption of the International League of Associations for Rheumatology criteria. Because fewer studies have described JPsA compared with other JIA subtypes, they retrospectively reviewed clinical records for all patients meeting JPsA criteria and divided them into four groups based on onset type and clinical features. Then, they compared characteristics at presentation and over follow-up.

The cohort included 119 patients: 65 (55%) with oligoarticular onset (persistent 44, extended 21), 34 (29%) with RF-negative polyarticular disease, 4 (3%) with RF-positive polyarticular disease, and 16 (13%) with enthesitis-related arthritis (ERA). At diagnosis, patients with ERA were the oldest and more often male. Patients with a polyarticular course more commonly had small-joint involvement of the hands and wrists, whereas patients with ERA more frequently had hip and sacroiliac arthritis. Nail changes were common (57%) and associated with distal interphalangeal involvement. Over time, patients with a polyarticular course took longer to reach inactive disease while on therapy (not off therapy) and were more likely to develop contractures than the other groups. Overall, long-term outcomes were generally favorable, and JPsA did not appear to form a clearly distinct subgroup—its patterns largely mirrored other JIA onset types without psoriasis.

Reference: Butbul Aviel Y, Tyrrell P, Schneider R, et al. Juvenile Psoriatic Arthritis (JPsA): juvenile arthritis with psoriasis? Pediatr Rheumatol Online J. 2013 Mar 15;11(1):11. doi: 10.1186/1546-0096-11-11. PMID: 23497068; PMCID: PMC3622582.

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.

Uveitis—immune-mediated inflammation of the iris/ciliary body, vitreous, choroid, and/or retina—demands tight co-management between ophthalmology and rheumatology. Etiologies span infections, malignancy “masquerades,” drug reactions, ocular syndromes, and, most commonly, systemic immune disease. Pattern recognition guides the differential: HLA-B27 disease typically causes unilateral, acute, recurrent anterior uveitis; Behçet’s is usually bilateral with retinal vasculitis; juvenile idiopathic arthritis causes insidious, bilateral chronic anterior uveitis. Collaboration is essential: ophthalmology rules out infection/masquerade; rheumatology pursues systemic causes and immunosuppression. Testing should be targeted—(eg, syphilis serology, chest imaging for sarcoid, HLA-B27 for acute unilateral anterior uveitis, urine β2-microglobulin for tubulointerstitial nephritis with uveitis) with awareness that many cases remain idiopathic.

Treatment is stepwise: topical steroids first. If insufficient, periocular/intravitreal steroids or short courses of oral steroids, then steroid-sparing agents. Robust trial data support adalimumab for non-infectious intermediate/posterior/panuveitis and for juvenile idiopathic arthritis-associated chronic anterior uveitis. TNF inhibitors are highly effective in Behçet’s but should be avoided in multiple sclerosis. Clinical trials are challenging given disease heterogeneity, but guidelines provide consensus care pathways.

Top of Form

Reference: Rosenbaum JT, Dick AD. The Eyes Have it: A Rheumatologist's View of Uveitis. Arthritis Rheumatol. 2018;70(10):1533-1543. doi: 10.1002/art.40568.

A systematic review across Medline, PubMed, Scopus, and Web of Science (inception–November 30, 2024) screened 3,163 records and included 33 studies on obesity/comorbidities in psoriatic arthritis (PsA). Obesity—present in nearly half of patients with PsA—emerged as the most consistent risk factor for developing PsA from psoriasis and is linked to higher disease activity, delayed diagnosis, and poorer response to biologic disease-modifying antirheumatic drugs. Beyond adiposity, PsA commonly clusters with metabolic syndrome, dyslipidemia, hypertension, diabetes, cardiovascular disease, and mood disorders. Emerging genetic/biologic data implicate PCSK9 in psoriasis risk, though real-world effects of PCSK9 inhibitors on PsA remain untested.

Management should be multidisciplinary and treat both articular/skin inflammation and cardiometabolic comorbidities, with the rheumatologist coordinating care. Lifestyle interventions—dietary modification and physical activity—are foundational but show person-to-person variability. Newer anti-obesity medications can lower body mass index and improve cardiometabolic parameters, potentially enhancing overall PsA outcomes. Proactive identification and treatment of obesity and related conditions are therefore central to achieving better disease control and long-term results.

Reference: Maharaj AB, Eder L, Ogdie A. Obesity and Comorbidity Management in Psoriatic Arthritis. Rheum Dis Clin North Am. 2025;51(3S):e1-e18. doi: 10.1016/j.rdc.2025.07.001.

Psoriatic arthritis (PsA) often follows psoriasis, but how skin disease drives joint inflammation has been unclear. This study shows that epidermal changes alone can initiate PsA-like disease: mice lacking SPRY1 specifically in keratinocytes (Spry1-cKO) spontaneously developed psoriasiform dermatitis that progressed to arthritis with classic histology and inflammatory signatures. Transcriptomics aligned with human psoriatic skin, and human datasets showed greater SPRY1 downregulation in PsA lesional skin, supporting clinical relevance. The model also reproduced dactylitis, bone erosions, and elevated C-reactive protein with preserved rheumatoid factor, mirroring clinical PsA features.

Mechanistically, loss of SPRY1 amplified IFN-γ–JAK1/2–STAT1 signaling in keratinocytes, causing excess CXCL10. Rather than acting through CXCR3 or TLR4, CXCL10 bound CD14 on periarticular CD14^hi macrophages, activating PI3K/AKT and NF-κB to drive TNF-α–dominated inflammation and bone damage. Neutralizing CXCL10 or TNF-α, blocking CD14, depleting macrophages, or inhibiting JAK signaling each attenuated disease. Human single-cell synovial data likewise highlighted highly inflammatory CD14⁺ macrophages. Together, the keratinocyte SPRY1 → CXCL10 → CD14^hi macrophage → TNF-α axis emerges as a key skin-joint conduit and a set of therapeutic targets to prevent progression from psoriasis to PsA.

Reference: Xu F, Cui YZ, Yang XY, et al. CXCL10 secreted by SPRY1-deficient epidermal keratinocytes fuels joint inflammation in psoriatic arthritis via CD14 signaling. J Clin Invest. 2025;135(15):e186135. doi: 10.1172/JCI186135.

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

Psoriatic arthritis (PsA) presents with diverse manifestations, including peripheral arthritis, enthesitis, tenosynovitis, dactylitis, axial involvement, and skin and nail psoriasis. The condition is often complicated by comorbidities such as cardiovascular disease, diabetes mellitus, metabolic syndrome, gout, anxiety, and depression. Management approaches encompass both non-pharmacological and pharmacological interventions. Non-pharmacological strategies include patient education, lifestyle modifications, physiotherapy, and occupational therapy. Pharmacological treatments are tailored to the patient’s clinical profile and may involve non-steroidal anti-inflammatory drugs for symptomatic relief; conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), such as methotrexate, leflunomide, and sulfasalazine; and biologic and targeted synthetic DMARDs, including tumor necrosis factor-alpha inhibitors, phosphodiesterase 4 antagonists, and more. There is a need for biomarkers to predict therapeutic responses, aiming to facilitate a more personalized treatment approach for PsA patients.

Reference: Kharouf F, Gladman DD. Advances in the management of psoriatic arthritis in adults. BMJ. 2024;387:e081860. doi:10.1136/bmj-2024-081860

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.

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.

This mixed-methods study examined how patients and clinicians prioritize aspects of psoriatic arthritis (PsA), highlighting key differences that can impact care. Researchers conducted focus groups with 24 patients with PsA across three US rheumatology centers, followed by a three-round Delphi survey with 38 patients and 13 expert clinicians. Using anthropological methods, they identified 51 domains reflecting both clinical symptoms and lived experience. While both groups agreed on the importance of arthritis, pain, fatigue, and physical function, patients emphasized quality-of-life concerns such as access to care, sleep, and future health uncertainty—areas clinicians rated lower.

Findings showed patients often prioritize the broader life impact of PsA, while clinicians focus more on clinical manifestations like dactylitis and structural damage. The study suggests that patient care could benefit from tools that better capture individual concerns and support shared decision-making. A brief, personalized questionnaire could help bridge this gap and foster more meaningful clinic conversations. Although limited by a relatively homogenous patient population, the research underscores the need to integrate patient voices more directly into PsA care planning.

Reference: Mease PJ, Husni ME, Siegel E, et al. What Matters in Psoriatic Arthritis: A Comparison of Patient and Clinician Perspectives. ACR Open Rheumatol. 2025 Jan;7(1):e11781. doi: 10.1002/acr2.11781. PMID: 39800893; PMCID: PMC11725532.

The diagnosis of psoriatic arthritis (PsA) is frequently delayed due to variable clinical presentations and the lack of specific biomarkers. Genetic susceptibility, environmental triggers, and immune system dysregulation—particularly via the IL-23/Th17 pathway—contribute to disease onset and progression. Biologic and small-molecule therapies targeting TNF-α, IL-17, IL-23, and JAK pathways have significantly improved patient outcomes by reducing inflammation and preventing joint damage.

Mounting evidence also links gut microbiota dysbiosis with PsA development. Studies show that patients with PsA have reduced microbial diversity and lower levels of butyrate-producing bacteria such as Faecalibacterium and Akkermansia, which help maintain gut integrity and immune balance. Dysbiosis may contribute to systemic inflammation and immune dysfunction, potentially triggering or worsening PsA. Microbiota-focused interventions—probiotics, prebiotics, fecal microbiota transplantation (FMT), phage therapy, and dietary changes—are under investigation as adjunctive treatments. While early results are encouraging, more research is needed to determine their safety, efficacy, and role in personalized PsA care.

Reference: Bonomo MG, D'Angelo S, Picerno V, et al. Recent Advances in Gut Microbiota in Psoriatic Arthritis. Nutrients. 2025 Apr 11;17(8):1323. doi: 10.3390/nu17081323. PMID: 40284188; PMCID: PMC12030176.