State-of-the-Art Approaches to Rheumatic Disease Diagnosis, Management & Treatment

PsA: 2018 Update

Iaian B. McInnes, MD, PhD, Muirhead professor of medicine at the University of Glasgow, U.K., finished the day’s presentations with a talk on PsA. He began by describing the clinical and radiographic heterogeneity of PsA, which includes synovitis, enthesitis, osteitis and skin/nail disease. He noted that although many different types of rashes exist, they are all called psoriasis.

However, Dr. McInnes emphasized that PsA is not RA with a rash. “It is a clinical catastrophe for the many young people who it afflicts,” he explained. The disease extends beyond the classical manifestations to eye disease, psychiatric disease, gastrointestinal disease and more. “Cytokines and brain function are intimately related to each other,” explained Dr. McInnes, adding, “Depression is a part of the inflammatory syndrome and not a consequence of failing to deal with the disease.” Patients find it helpful to learn depression may be a manifestation of PsA.

Approximately half of patients with PsA have microscopic gut inflammation. Over five years, 20% of PsA patients will develop chronic inflammation and 6% will develop Crohn’s disease. Patients with PsA and psoriasis are also at increased risk of cardiovascular morbidity.

Even in patients who do not report musculoskeletal disease, psoriasis may extend beyond cutaneous disease. Moreover, many patients who appear to have only cutaneous symptoms also have subclinical synovitis, which suggests the arthritis probably starts much earlier than traditionally believed. Debate still exists over whether aggressive treatment of cutaneous psoriasis can prevent musculoskeletal disease. Research does suggest that, when it comes to treatment, time matters. Early recognition of disease matters, because even a six-month delay in diagnosis means the patient is more likely to experience functional disability and less likely to experience remission.

Dr. McInnes concluded his presentation by calling on members of the audience to “make the diagnosis early and treat aggressively and according to guidelines and recommendations. … Please treat the psychological impact. If you can do that, your patients will be infinitely better.”

Lara C. Pullen, PhD, is a medical writer based in the Chicago area.

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