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

Skin Therapy Letter. 2008;13(4):4-8.

Conclusion

The dermatologist is in a strategic position for early diagnosis, intervention, and appropriate management of the patient with PsA at its onset. The skin and joint involvementin PsA can significantly affect a patient's function and quality of life, and may increase cardiovascular morbidity and mortality.^[24] These effects, in turn, may have significant impact on the family and society in general. Early diagnosis and effective therapy for PsA can prevent the progression of joint damage, and possibly induce a remission of the disease.

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References

PsA Classification Subgroups (proposed by Moll and Wright ^[5])
Form of PsA	Frequency	Joint Distribution	Other Features
Oligoarticular asymmetrical arthritis	70%	≤ 4 joints	dactylitis and/or monoarthritis
Symmetrical polyarthritis	15%	5 joints	erosive and metacarpophalangeal joint involvement
Predominantly DIP arthritis	5%		severe nail psoriasis
Arthritis mutilans	5%	May not have severe general disease	telescoping of fingers and toes, often associated with sacroiliitis
Spinal form	5%	Sacroiliitis	can be asymptomatic, uni/bilateral sacroiliitis, ± peripheral joints

DIP = PsA in the distal interphalangeal joints of the hands observations.

Clinical Features in Psoriatic Arthritis and Other Seronegative Arthropathies (adapted from Brockbank and Gladman ^[17])
Clinical Feature	Psoriatic Arthritis	Rheumatoid Arthritis	Ankylosing Spondylitis	Reactive Arthritis	IBD
Gender	Males=Females	Males	Males>Females	Males>Females	Males=Females
Most common joint pattern	Oligoarticular/polyarticular (asymmetric)	Polyarticular (symmetric)	Oligoarticular (lower limb)	Oligoarticular (lower limb)	Oligoarticular (lower limb)
DIP joint	High	Low	Does not occur	Does not occur	Does not occur
Dactylitis	High	Does not occur	Low	Medium	Low
Enthesitis	Medium	Does not occur	Medium	High	Medium
Spondylitis	Medium	Does not occur	High	Low	Medium
Sacroiliitis	Asymmetric	Does not occur	Symmetric	Asymmetric	Symmetric
Eye symptoms	Low	Medium	Medium	High	Low
Skin/nail lesion	High	Does not occur	Does not occur	Medium	Does not occur
Rheumatoid factor positive	Does not occur	High	Does not occur	Does not occur	Does not occur

DIP = PsA in the distal interphalangeal joints of the hands

PsA Classification Subgroups (proposed by Moll and Wright ^[5])
Form of PsA	Frequency	Joint Distribution	Other Features
Oligoarticular asymmetrical arthritis	70%	≤ 4 joints	dactylitis and/or monoarthritis
Symmetrical polyarthritis	15%	5 joints	erosive and metacarpophalangeal joint involvement
Predominantly DIP arthritis	5%		severe nail psoriasis
Arthritis mutilans	5%	May not have severe general disease	telescoping of fingers and toes, often associated with sacroiliitis
Spinal form	5%	Sacroiliitis	can be asymptomatic, uni/bilateral sacroiliitis, ± peripheral joints

DIP = PsA in the distal interphalangeal joints of the hands observations.

PsA Classification Subgroups (proposed by Moll and Wright ^[5])
Form of PsA	Frequency	Joint Distribution	Other Features
Oligoarticular asymmetrical arthritis	70%	≤ 4 joints	dactylitis and/or monoarthritis
Symmetrical polyarthritis	15%	5 joints	erosive and metacarpophalangeal joint involvement
Predominantly DIP arthritis	5%		severe nail psoriasis
Arthritis mutilans	5%	May not have severe general disease	telescoping of fingers and toes, often associated with sacroiliitis
Spinal form	5%	Sacroiliitis	can be asymptomatic, uni/bilateral sacroiliitis, ± peripheral joints

DIP = PsA in the distal interphalangeal joints of the hands observations.

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