Psoriatic Arthritis: Disease Burden

Lana Dykes: Hello, and welcome to this Rheumatology Network™ K-Cast titled “Expert Perspective on the Management of Psoriatic Arthritis.” I’m Lana Dykes, editor of Rheumatology Network™, and joining us today is Dr Chris Parker, chief of rheumatology at Austin Diagnostic Clinic.

Today, Dr Parker will share strategies for the treatment of patients with psoriatic arthritis, including the importance of an early diagnosis. He will also review available therapies, and discuss how rheumatologists can coordinate with primary care teams to support patient needs. Let’s get started.

Hi, Dr Parker. Thank you for joining me.

Christopher Parker, DO: You’re welcome. Hi, Lana.

Lana Dykes: To begin, can you briefly describe the pathophysiology, prevalence, and disease burden of psoriatic arthritis?

Christopher Parker, DO: To me, one of the fun parts about dealing with a condition like psoriatic arthritis is, when patients show up in my clinic they might have very mild disease or it could be very bad, destructive disease with lots of psoriasis all over the body, and everything in between. So, the disease burden is vast, in that regard. It’s up to me, early on, to try to assess where they are in the stage of their condition.

Lana Dykes: Can you elaborate on the importance of an early and accurate diagnosis of psoriatic arthritis?

Christopher Parker, DO: Yes, I think that’s really important. So, early and accurate. Accurate is important for all aspects of medicine. You need a firm diagnosis. The thing about an early diagnosis is, this is very similar to other arthritities and other, I’ll say, systemic conditions in rheumatology. If you have a condition that may be destructive, permanently destructive, of course you want to diagnose it early so you can try to prevent that. This is where that ounce of prevention is worth a pound of cure, if that’s what your mom or grandma used to say. I’ve heard it a million times. It certainly applies in this situation. And for that reason, at least in my town, Austin, Texas, dermatologists are exquisitely familiar with this and understand it. I’m lucky to live in a community where clinicians are pretty darn good at getting people over to me if there is a hint in the clinic that someone with psoriasis may have psoriatic arthritis.

Lana Dykes: Can you touch on the impact of quality of life for patients with psoriatic arthritis?

Christopher Parker, DO: Sure. I’ll start by saying my brother developed psoriasis and then later psoriatic arthritis, so I had an understanding of how someone could be treated like a pariah as a kid. It’s visual, and we all care about how we look. And so, if you’re in a place like sunny Texas or wherever else, you’re going to go swimming and you have this scaly rash. People may not know it’s psoriasis and that it’s not contagious. I feel like in terms of disease burden, that’s something that’s hard to measure—how it feels to have that condition visually, how you’re treated. People are treated differently, though, when they have something visual. No doubt about it.

Then when it comes to the person’s physical aspects of dealing with psoriasis, patients report to me that the condition can be itchy. For anybody who’s had a bad itch, particularly at night, this is very disruptive to sleep and that’s its own issue, in terms of quality of life. I’ve had some reports of itching so bad that there are fantasies about scratching with a fork or something like that. I would say most of my patients with psoriasis patients don’t do that, but itchiness certainly is an issue.

Also, it can bleed. That can be embarrassing if it’s on your clothes. One of the young ladies I saw today is preparing to get married here in sunny Texas. We’re about 6 months out, and she talks about how having a wedding dress with long sleeves in Texas doesn’t make sense, but she doesn’t want to have all of this be seen, and stuff like that. And so that is impairing in lots of different ways.

Then, of course, the arthritis part. It’s not particular to psoriatic arthritis. Certainly, my patients with rheumatoid arthritis and other arthritities will report pain, stiffness, poor function, difficulty doing things. All of those things really impact a patient’s quality of life.

Transcript edited for clarity.