Understanding the link between PsO and PsA
Elizabeth, actual patient with PsO and PsA on COSENTYX®, was compensated for her time. Individual results may vary.
Regardless of skin clearance results seen on biologic therapy, your patients with PsO may be at risk for developing PsA1
Up to 41% of patients with PsO may also have PsA; can you predict who is at higher risk?2
WHAT TO LOOK FOR
RED FLAGS
Nail psoriasis
~3X higher risk3* for developing PsA
Scalp psoriasis
~4X higher risk3* for developing PsA
>80% of patients develop PsA AFTER they have been diagnosed with PsO.4
WHAT TO ASK
IS IT PsA?5
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Patients with PsO and/or a strong family history of PsO plus ≥2 items listed in the PsA mnemonic should prompt a screening or PsA and/or referral to a rheumatologist.6
Screening and treating patients with PsO for PsA can help stop further irreversible joint damage.
When your patients with PsO develop PsA, their joints are in danger1
Artist’s representation of early radiographic damage.
One study revealed PsA can cause irreversible joint damage in as little as 6 months from symptom onset.6
Another study found that ~1 in 4 patients with early PsA had at least 1 erosion.7†
IL-17A cytokines play a key role in inflammation and bone erosion8
Choice of therapy is critical
Spinal symptoms are present in up to 50% of patients with PsA.9
In patients with axial PsA, EULAR‡ recommends to use IL-17A inhibitors FIRST, before all other b/tsDMARDs (including IL-17A/F inhibitors, TNF inhibitors, and JAK inhibitors).10
IL-23 inhibitors are not recommended due to negative trial results for IL-12/23 inhibitors in axial PsA by EULAR.10
†Results from a study that examined a cohort of 122 patients presenting with early PsA (≤5 year symptom duration).7
‡The updated 2023 EULAR Guidelines expand on the previous 2019 recommendations for the pharmacological management of PsA. Updated recommendations were developed by a steering committee and task force of members from 19 different countries and are based on a systematic literature review from the end of 2018 through April 2023; experience- and consensus-based considerations were also examined. The levels of evidence and grades of recommendation were determined based on the levels of evidence established by the Oxford Centre for Evidence-Based Medicine. Novartis is one of the many corporate supporters of the EULAR network.10
Definitions
b/tsDMARDs, biologic/targeted synthetic disease-modifying antirheumatic drugs; EULAR, European Alliance of Associations for Rheumatology; IL, interleukin; JAK, Janus kinase; PsA, psoriatic arthritis; PsO, plaque psoriasis; TNF, tumor necrosis factor.
References
1. van Muijen ME, van Hal TW, Groenewoud HMM, van den Reek JMPA, de Jong EMGJ. The skin may clear but the arthritis won’t disappear: focusing on concomitant and new-onset psoriatic arthritis in a daily practice cohort of psoriasis patients on biologic therapy. Psoriasis (Auckl). 2020;10:29-37.
2. Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol. 2019;71(1):5-32.
3. Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009;61(2):233-239.
4. Hioki T, Komine M, Ohtsuki M. Diagnosis and intervention in early psoriatic arthritis. J Clin Med. 2022;11(7):2051.
5. Cohen JM, Husni ME, Qureshi AA, Merola JF. Psoriatic arthritis: it’s as easy as “PSA”. J Am Acad Dermatol. 2015;72(5):905-906.
6. Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74(6):1045-1050.
7. Hen O, Di Matteo A, Dubash SR, et al. High prevalence of radiographic erosions in early, untreated PsA: results from the SpARRO cohort. RMD Open. 2024;10(2):e003841.
8. Tang M, Lu L, Yu X. Interleukin-17A interweaves the skeletal and immune systems. Front Immunol. 2021;11:625034.
9. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376(10):957-970.
10. Gossec L, Kerschbaumer A, Ferreira RJO, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis. 2024;83(6):706-719.