Psoriatic arthritis (PsA) is a form of inflammatory arthritis that affects up to 30% of people with psoriasis. With five different forms and a wide range of symptoms, PsA can be confounding to diagnose and treat.
Physicians treating psoriatic disease can benefit from up-to-date clinical guidance, such as the National Psoriasis Foundation's (NPF) comprehensive Psoriasis and Psoriatic Arthritis pocket guide for physicians, along with resources for patients.
It's equally important for clinicians to support patients by providing them information and answering their questions about PsA, which can alleviate their stress and anxiety.
If you're a rheumatologist or dermatologist, there's a good chance you're familiar with psoriatic arthritis (PsA), a type of inflammatory arthritis associated with psoriasis that affects nearly 2.1 million people in the US alone.
With five distinct types and a wide range of symptoms, PsA can be challenging to treat. Individual cases may present differently, sometimes affecting only four joints in the body, other times affecting far more than four—along with possible nail and eye involvement. PsA can require a variety of interventions, and often involves multidisciplinary teams.
The following resources are intended to help you achieve optimal outcomes for your patients, and answer their questions along the way.
The NPF's pocket guide for physicians
A must-have resource for any physician treating PsA, The Psoriasis and Psoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options is a comprehensive guide published by the National Psoriasis Foundation (NPF).
Authored by some of the nation's leading dermatologists and rheumatologists, the pocket guide provides extensive information about PsA and up-to-date guidance for managing patients with both PsA and psoriasis.
Now in its 8th edition, the guide boasts seven chapters of treatment algorithms and management options, with an introductory section that covers just about every angle of PsA you can imagine. Topics include:
How to effectively assess patients
Treatment selection (NSAIDs; methotrexate; biologics; physical therapy)
Algorithms for patient-specific situations—such as individuals with HIV infection and psoriasis, or women of childbearing potential with psoriasis—to give a holistic understanding of how PsA may operate alongside other conditions
Side effect profiles of the numerous treatments used in psoriasis and PsA
Infection risk assessment for patients who are pursuing therapies
Insurance advocacy, which may help patients to better access quality care
ACR's Fast Facts sheet
While there is no cure for PsA, having an understanding of the disease and knowing what to expect along the treatment journey can reduce patient anxiety and discomfort.
The American College of Rheumatology (ACR) offers physicians a succinct and convenient article to answer some of the most common questions asked by patients.
This Fast Facts sheet defines PsA, discusses who gets it, and provides detailed responses to questions pertaining to diagnostics, treatment, broader health impact, and the rheumatologist’s role in helping patients manage their symptoms.
One observation, under the section titled “Living with Psoriatic Arthritis,” addresses the value of exercise and movement in keeping joints flexible and healthy.
"Many people with psoriatic arthritis also benefit from physical and occupational therapy,” the authors wrote, “to strengthen muscles, protect joints from further damage, and increase flexibility.”
"Aqua therapy can be beneficial, as some people with arthritis find it easier to move in water. "
— American College of Rheumatology fact sheet
AAD diagnosis and treatment sheet
The American Academy of Dermatology Association’s (AAD's) article on diagnosis and treatment related to PsA, is another helpful resource that can be shared with patients.
This article dives into how PsA is diagnosed, which may require a close look at their medical records, extensive questioning about family history, an examination of the joints, and, potentially, x-rays and blood tests.
This educational material about PsA can provide patients with a solid background on the disease and help them understand the rationale for your treatment plan.
As the patient will learn, treatment may involve physical, occupational, or massage therapies, appropriate exercise and rest regimens, devices to protect affected joints, and the need for medicines or even surgery.
The use of disease-modifying, anti-rheumatic drugs (DMARDs) to treat PsA is explained. DMARDs mitigate pain and swelling. Methotrexate and injectable biologics are two DMARDs used to manage PsA symptoms.Related: Many RA patients are resistant to DMARD therapy. Here's how to address this obstacle head-on
NPF's Screen for PsA test
The NPF has created the Screen for PsA test, an easy, free, at-home screening tool that patients can complete at any time.
Designed to help patients identify possible symptoms of PsA, the Screen for PsA consists of five questions:
Have you ever had a swollen joint (or joints)?
Has a doctor ever told you that you have arthritis?
Do your fingernails or toenails have holes or pits?
Have you had pain in your heel?
Have you had a finger or toe that was completely swollen and painful for no apparent reason?
Based on the number of “yes” answers, the test will let the patient know whether they are likely to be struggling with PsA.
This is a resource that patients (especially those with psoriasis) can return to every 6 months to check in about the progression of their symptoms—and one that they can use to gauge when it’s time to set up an appointment with you for further testing.
What this means for you
Psoriatic arthritis—with its five different forms, and a wide range of presentations—can be confounding to diagnose and treat. You can enhance your own understanding of PsA by referring to the diagnostic and treatment materials provided by the National Psoriasis Foundation, the American Academy of Dermatology, and the American College of Rheumatology. These organizations also offer useful resources to help answer your patients' questions and alleviate some of their anxiety about their disease.
This article is part of Room for Better Rheum Care, where physicians and patients share the latest research, tips, and strategies for raising treatment expectations and delivering improved care in RA, PsA, and nr-AxSpA.