Patient-Centered Care in Psoriatic Arthritis—A Perspective on Inflammation, Disease Activity, and Psychosocial Factors

Abstract

Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by skin lesions, dactylitis, and enthesitis. Patients with PsA suffer from a variety of psychosocial difficulties and nonspecific symptoms early on in the disease course and continue to experience progressive disease due to delays in diagnosis and treatment. Symptoms initially viewed as somatization could lead to undertreatment and promote psychological distress, poor coping, and negative patient–provider relationships. Pain and fatigue are important complaints that affect the patient’s perception and may need to be addressed with a multidisciplinary approach. Maladaptive cognitive responses can lead to a negative illness perception and impact patient beliefs and concerns over treatment, as well as nonadherence. An underlying inflammatory component in affective disorders has been examined, though whether and how it may interact mechanistically in PsA warrants interest. Cognitive behavioral therapy represents a nonpharmacological treatment modality that can be combined with cytokine-targeted therapy to address both somatic and psychological complaints. Future directions for research include: (1) Elucidating nonspecific manifestations (e.g., subclinical stage, differential with functional syndromes) of PsA and how they impact diagnosis and management; (2) characterizing immune-mediated components of mood disorders in PsA; and (3) whether a bidirectional approach with abrogating inflammation and psychotherapeutic support leads to improved outcomes.

Follow-Up Comparison of Fluorescence Optical Imaging With Musculoskeletal Ultrasound for Early Detection of Psoriatic Arthritis

“…The visualization of changes in microcirculation and vascularization by FOI may enable the detection of a very early PsA disease state in a presubclinical phase -in transition to a clinical stage (29). This is underlined by the hypothesis that non-specific musculoskeletal symptoms in patients with psoriasis may actually represent a preclinical phase of PsA (30,31). In addition, Faustini et al reported that the risk for developing PsA was as high as 60% if patients had subclinical synovitis and symptoms related to arthralgia highlighting the importance to establish an early PsA diagnosis (32).…”

Somatization in dermatology

“…Alexithymia, or the inability to describe one's emotions, positively correlates with somatization in patients with psoriasis, especially in women and also when the face, hands or genitals are involved 25,26 . Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by skin lesions, dactylitis, and enthesitis 27 . Patients with PsA often suffer from a number of psychosocial problems and also nonspecific symptoms early on in the course of the disease 27 .…”

“… 25 , 26 Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by skin lesions, dactylitis, and enthesitis. 27 Patients with PsA often suffer from a number of psychosocial problems and also nonspecific symptoms early on in the course of the disease. 27 They continue to experience progressive disease due to delays in diagnosis and treatment.…”

Comorbidity in Adult Psoriasis: Considerations for the Clinician

“…Despite the well-established association between mental disorders and psoriasis, and the fact that early diagnosis of mental illness has proven important, mental disorders in patients with psoriasis are underrecognised and undertreated. 108 , 109 , 123 , 124 Screening for mental health disorders, especially in patients with psychiatric risk factors, and consideration of psychotherapy of patients with psoriasis are thus imperative. 105 , 111 , 117 …”