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 “The important takeaway point for a lay audience would be that
further education is needed for patients with psoriasis about the
potential that they may develop psoriatic arthritis,” said Dr. Abby
Van Voorhees, director of the Psoriasis and Phototherapy Treatment
Center at the Hospital of the University of Pennsylvania in
Philadelphia.
Van Voorhees was not part of the new review.
Only about one in four people with psoriasis will develop related
arthritis, but everyone with psoriasis should be aware of the
potential, she told Reuters Health by phone.
“We don’t understand how the connection works at this point,” she
said.
Researchers from French institutions including Universite Claude
Bernard Lyon and Universite de Bordeaux, along with others, reviewed
12 previous studies of people with psoriasis. The rate of
undiagnosed psoriatic arthritis in the studies varied from four
percent to almost 34 percent of patients.
The studies used very different diagnostic criteria for identifying
arthritis, which may explain why the rates were so different between
papers, the authors write in the Journal of the American Academy of
Dermatology.
Reviewing all of the studies together, they predict that about 15
percent of the psoriasis patients a dermatologist sees at a
dermatologic center may have undiagnosed psoriatic arthritis.
Many patients many have joint pain and other symptoms and “not know
it is an important condition,” Van Voorhees said.
Psoriatic arthritis can be treated with non-steroidal
anti-inflammatory drugs like aspirin, immunosuppressive drugs like
methotrexate, or biologic drugs given by injection or infusion.
Catching arthritis earlier means treatment can start earlier and
more joint damage can be prevented, Van Voorhees said.
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Dermatologists and primary care doctors are often the first to see
patients with joint symptoms, and some are less aware of the need to
screen for psoriatic arthritis, she said. In other cases, patients
don’t mention their pain because they attribute it to “just getting
older,” she said.
“Psoriatic arthritis can (start) with swollen and tender joints and
with lower back pain and stiffness,” said Dr. Abrar A. Qureshi,
chair of the dermatology department at Brown University in
Providence, Rhode Island. “As psoriasis patients are seeing a
dermatologist, they do not bring up pain and stiffness as most
patients do not make the link between the skin and musculoskeletal
disease.”
Qureshi was not part of the new review.
“Dermatologists are beginning to catch on and ask more patients
about pain and stiffness,” he told Reuters Health by email.
Van Voorhees routinely asks patients about their joint pain, what
time of day it happens, in which joints, and takes a blood test to
exclude rheumatoid arthritis.
“We want to be sure that the inflammation that does occur in
patients is caught as early as possible,” she said. “What you don’t
ask about, sometimes we don’t learn about.
SOURCE: http://bit.ly/1CdZJdD Journal of the American Academy of
Dermatology, online June 5, 2015.
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