Psoriatic Arthritis: Education, Awareness Among Docs Too Low

Diedtra Henderson

August 01, 2014

Psoriatic arthritis (PsA), which remains woefully underdiagnosed and misdiagnosed, could be treated earlier, lessening the disease burden, if patients and clinicians were more aware of the ailment, if effective screening tools existed, and if there were a more straightforward way to determine when referrals and treatment by rheumatologists were appropriate, according to a consensus statement.

One in 20 people who suffer from psoriasis, a skin ailment, also develop PsA, according to the National Institutes of Health. The disease severity ranges from mild, affecting just a few joints, to severe, which can cause stiffness, burning, and pain in joints and spine. PsA is associated with a higher risk of suffering additional ailments, such as cardiovascular disease, hypertension, type 2 diabetes, or obesity.

However, approximately 50% of patients with psoriasis have undiagnosed PsA, according to the authors of a consensus statement published online July 21 in Arthritis Care & Research. In addition, many patients who are diagnosed view treatment as being as problematic as the disease itself.

International experts gathered at the Psoriatic Arthritis Forum in London in October 2012 to identify treatment and diagnosis gaps and to outline solutions to those unmet needs, Philip Helliwell, PhD, DM, FRCP, from the Leeds Institute of Molecular Medicine, University of Leeds, United Kingdom, and colleagues write in the newly published statement.

Experienced rheumatologists can spot psoriatic arthritis, but a biomarker that reliably predicts which patients with psoriasis will progress to arthritis would be valuable, Dr. Helliwell and colleagues note. In addition to the lack of well-validated tools to identify PsA, neither clinicians nor patients are aware of what distinguishes the disease from the more prevalent inflammatory arthritis or osteoarthritis.

"Education on PsA screening should be directed to healthcare providers who are most likely to have contact with PsA patients, including dermatologists, [primary care physicians], ophthalmologists, orthopedists, rheumatologists, podiatrists, and physical therapists," the authors write. "Among these, dermatologists might be the focus of greater efforts, as patients are likely to have more severe skin disease associated with PsA development."

Andrew D. Robertson, PhD, chief scientific and medical officer at the National Psoriasis Foundation, endorsed the findings, telling Medscape Medical News that the "well-reasoned" document will help the field focus and prioritize the most important strategies to improve patient care.

"I can't say things will change tomorrow, but I can say this consensus statement provides us with guidance and also, frankly, with some motivation to continue what we're doing and expand what we're doing," Dr. Robertson said. "We don't need to do new research. We just need to help on the awareness and education side to make a difference in people's lives now," he told Medscape Medical News.

Up to 4 years can pass with patients being unaware they have psoriatic arthritis, he said. "People are suffering needlessly."

The consensus statement authors say it remains unclear whether early or intense treatment prevents progression of the disease, which impairs quality of life, increases disability, and exacts high direct and indirect costs. However, patients who are seen in the first 2 years of having the disease have a slower rate of progression than patients who are seen after having the disease for 2 years. The authors call for additional studies to bolster a randomized, controlled inquiry that found improved joint and skin outcomes in newly diagnosed patients who received intensive management of PsA.

"The actions outlined here address near-term goals, including promoting awareness of PsA and its associated burden, as well as longer-term goals, including defining and implementing consistent standards of detection and care," the authors conclude. "Ultimately, the recommended actions are intended to improve disease-related and functional outcomes and [health-related quality of life] of PsA patients."

Financial assistance for the roundtable discussions was provided by Celgene Corporation, which also provided support for writing resources. Dr. Robertson has disclosed no relevant personal financial relationships but disclosed that the National Psoriasis Foundation receives funding from major manufacturers of mechanical and pharmaceutical therapies for psoriatic arthritis.

Arthritis Care Res. Published online July 21, 2014. Full text

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