The Role of the Dermatologist in Identification and Treatment of the Early Stages of Psoriatic Arthritis

Skin Therapy Letter. 2008;13(4):4-8. 

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The Role of the Dermatologist

The recognition and early treatment of PsA is analogous to that of acne. We are aware of the importance of early recognition of acne and the urgency in treating it aggressively in order to induce remission and prevent further damage. The destruction of the joints in PsA follows the same principle: treat early to prevent the damage. The dermatologist who monitors a psoriatic patient can detect PsA at its earliest stage.

A study by Zanolli and Wikle concluded that a large portion of patients with psoriasis presenting to a dermatologist for treatment were recognized to have coexisting jointcomplaints; and the prevalence of PsA is greater than that identified by a nondermatologist.[21]

The prevalence of psoriasis is greater than PsA, and psoriasis typically precedes the joint complaints.[4,11,22] Therefore, the dermatologist is in a unique position to screen patients with psoriasis for PsA by maintaining a high index of suspicion and close follow-up. In limited cases, consultation with a rheumatologist may be necessary to make the diagnosis of PsA.

A screening questionnaire could be designed for patients presenting to the dermatologist for the first time with psoriasis. The Psoriasis and Arthritis Screening Questionnaire(PASQ)[23] that was developed by our group was created using the CASPAR criteria as its framework. This questionnaire does not replace a proper history, but reminds us toconsider the diagnosis of PsA in any patient with symptoms of psoriasis, regardless of the severity of the cutaneous manifestations.


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