Disease Characteristics and Sequence of Skin and Musculoskeletal Disease Onset in Psoriatic Arthritis The British Journal of Dermatology

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• The authors of this study used the Psoriatic Arthritis International Database, which includes patient information from Turkey, Canada, and Italy, to elucidate the temporal relationship between psoriasis (PsO) and psoriatic arthritis (PsA) onset. Among the 1631 patients in the registry, most patients developed PsO more than 1 year before PsA onset (76.8%); fewer patients had synchronous (less than 12 months apart) diagnosis of PsA and PsO (18.9%) or PsA onset more than 1 year prior to PsO onset (4.3%). Patients who developed arthritis first more often had oligoarthritis and axial involvement and less often had polyarthritis.

• Additional findings included the association between pustular psoriasis and earlier onset of PsA, whereas plaque psoriasis and nail involvement tended to have an association with later onset of PsA. The mean age of PsA diagnosis between 40.2 and 42.2 years and was relatively constant regardless of whether the onset of skin disease occurred before, after, or synchronously with joint disease.

– Caroline K. Crabtree, MD

Written by

 

 

Joseph Kamel DO

Written by

 

 

Neil J. Korman MD, PhD

The million-dollar psoriatic arthritis question is, will it occur (approximately 30% of psoriasis patients will develop psoriatic arthritis) and if it occurs, when will that be? This publication aims to establish the temporal relationship between diagnosing cutaneous psoriasis (PsO) and the development of psoriatic arthritis (PsA). A database containing 1631 patients with PsA and PsO, was grouped into three cohorts: PsA-diagnosed first (>12 months apart), PsO-diagnosed first (>12 months apart), and synchronous PsO and PsA (within 12 months of each other). Dermatologists are unlikely to encounter the PsA-first cohort, though it is reassuring to know this group makes up only 4% of patients. If or when the PsO-first or synchronous cohorts develop joint pain and present to our clinics, it is important that we assess the patient for PsA to facilitate systemic therapy, which may be necessary depending upon the severity of the PsA regardless of cutaneous disease severity. A very simple question for PsA screening that I have found to be most useful is asking if the patient has morning stiffness that lasts more than 30 minutes. Interestingly, in this study the authors found that patients with pustular psoriasis developed PsA earlier, although those with a family history of psoriasis developed PsA later. Although these data may help guide the patient's understanding of if or when they might develop PsA, the time lapse remains broad, which does not guide dermatologists in choosing the optimal time frame to screen for PsA at follow-up visits. Rather, the results of this important study emphasize the importance of obtaining a family history of psoriasis at the initial visit and performing PsA screenings at every visit as PsA can develop at any time.

Abstract 

The temporal relationship between the onset of skin psoriasis (Pso) and psoriatic arthritis (PsA) is a long and well-known feature of psoriatic disease. Psoriatic skin lesions emerge years before the development of musculoskeletal manifestations in nearly 75% of PsA patients. While skin and joint manifestations develop within one year in 15-20% of the patients, joint manifestations precede the skin involvement by a year or more in about 10% of the patients (1).

The British Journal of Dermatology

Association of Disease Characteristics With the Temporal Sequence of Skin and Musculoskeletal Disease Onset in Psoriatic Arthritis

Br J Dermatol 2021 Jan 22;[EPub Ahead of Print], K Tascilar, O Bayindir, A Dogru, I Tinazzi, G Kimyon, C Ozisler, A Erden, E Dalkilic, GY Cetin, S Yılmaz, D Solmaz, S Bakirci, A Omma, T Kasifoglu, O Kucuksahin, M Cinar, L Kilic, M Can, EF Tarhan, E Bilgin, ED Ersozlu, T Duruoz, S Yavuz, S Pehlevan, MA Tufan, E Gonullu, F Yildiz, SE Esmen, A Kucuk, A Tufan, A Balkarli, R Mercan, V Yazisiz, S Erten, S Akar, K Aksu, SZ Aydin, U Kalyoncu 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
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