Psoriatic arthritis: the role of the nonphysician clinician in the diagnosis and treatment of patients with psoriasis

Abstract

Psoriatic arthritis is a clinically heterogeneous, chronic, and progressive disease that develops in up to 30% of patients with psoriasis and is characterized by multiple and increasing joint defects caused by persistent immune-mediated inflammation. Several treatment options are available, including multiple biologic agents that inhibit specific cellular mediators of inflammation either directly or indirectly. Early detection and intervention are critical to preventing severe joint damage and pain, necessitating increased awareness and education about this disease for primary providers and nonphysician clinicians. Physician assistants and nurse practitioners, given their role in the primary care setting and within multiple specialty areas such as dermatology and rheumatology, are often the first to see patients who may have psoriatic arthritis. These healthcare providers are increasingly important in the early diagnosis and treatment of this disease. In this review, we provide an overview of psoriasis and psoriatic arthritis and discuss the multiple treatment options that are available for these patients. We also discuss ways to help recognize early joint involvement in the clinic and emphasize the role that nonphysician clinicians play in the care of patients with psoriatic arthritis. Key points Psoriatic arthritis, an inflammatory disease, may cause irreversible joint damage in patients with psoriasis. Physician assistants and nurse practitioners in dermatology and rheumatology, who are well positioned to recognize psoriatic arthritis early, treat patients, and prevent long-term complications, benefit from education on recognizing and treating psoriatic disease to improve outcomes. Biologics have demonstrated efficacy in several disease domains of psoriatic arthritis, and treatment guidelines generally recommend their use over that of nonbiologic agents.

Leukopenia that successfully treated by Ustekinumab in patient with psoriatic arthritis

“…Psoriatic arthritis (PsA) is a chronic inflammatory arthritis found in about 20% of patients with psoriasis (1). It has been estimated to have a prevalence of 0.05% to 0.25% in the general population and around 6% to 41% in psoriasis patients, usually in the 30s and 40s in both sexes (2).…”

Therapeutic Development Based on the Immunopathogenic Mechanisms of Psoriasis

“…In addition, about 50% psoriasis patients show nail (fingernail or toenail) involvement, and their clinical features include pittings, leukonychia, onycholysis, dyschromias, splinter hemorrhage, and nail bed hyperkeratosis. The disease may begin at any age, but it typically starts from the age of 15-25. Psoriatic inflammatory responses at the joints result in psoriatic arthritis, and up to 30-40% of individuals with psoriasis develop psoriasis arthritis between 30 and 50 years old [5][6][7][8].…”

“…The disease may begin at any age, but it typically starts from the age of 15–25. Psoriatic inflammatory responses at the joints result in psoriatic arthritis, and up to 30–40% of individuals with psoriasis develop psoriasis arthritis between 30 and 50 years old [ 5 , 6 , 7 , 8 ].…”