Tips for Recognizing the Signs of Psoriatic Arthritis

Diagnosing patients presents numerous challenges for health care professionals (HCP)—as you well know. While some patients present with telltale symptoms, it’s the rare patient who sits in your exam room with textbook disease symptomology—except those with the common cold, perhaps.

Experts agree autoimmune disorders are among the trickiest to diagnose. Psoriatic arthritis (PsA) is one such disease. Often, it first attacks the skin, causing itchy redness, scaling, and irritation; then it moves to the connective tissue and joints causing pain, stiffness, and swelling. True inflammatory markers like these could signal that more may be going on with your patient.

Thanks to mounting scientific evidence, we know inflammation is linked to other diseases. Psoriatic conditions are no different, and carry the risk of comorbid diseases such as heart disease, hypertension, and diabetes, says Randy Beranek, president and CEO of the National Psoriasis Foundation (NPF).

“Psoriasis affects skin cells but also other internal systems, so it’s critical that people are diagnosed promptly and get on a treatment to suppress inflammation,” says Beranek.

Psoriasis and psoriatic arthritis affect an estimated 125 million people worldwide, say experts from the International Federation of Psoriasis Associations.

At the 2014 American Academy of Dermatology annual conference in Denver, NPF announced plans to help physicians decrease the length of time in diagnosing psoriatic arthritis, from four years to just one year.

To achieve this goal, Beranek says the organization will “push messaging” out to both doctors and patients. It will also continue serving as an educational resource that helps people learn more about disease progression and treatment.

Psoriasis commonly shows up on the scalp (48% of cases), elbows (46%), and knees (31%), but can also manifest on the nails and genitals, as reported in the Journal of the American Academy of Dermatology, referencing the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey, which involved 3,426 patients and 781 physicians from the US, Canada, and several European countries.

Survey data also indicate that, “Patients with PsA reported joint pain in their knees (41%), fingers (26%), hips (19%), back/spine (18%), ankles (19%), and wrists (16%).”

Survey limitations include no control group or ethnic considerations.

Sounds like straightforward symptomology, yet many HCPs underdiagnose PsA. It’s important to understand the condition isn’t well understood. Plus, physicians and patients mistakenly consider psoriasis a “cosmetic” condition with few serious consequences, says Beranek.

Left untreated, medical experts say disease progression can cause permanent joint damage, which is why early treatment and intervention is recommended.

Kathleen Gallant, secretary of the International Federation of Psoriasis Associations, stands among those medical advocates and associations pushing the World Health Organization to “recognize psoriasis as [a] serious disease” with real economic consequences—especially considering those without health care coverage.

“Psoriasis and psoriatic arthritis must be recognized by both global and national health authorities, but unfortunately these diseases and their effects are often ignored and overlooked,” said Gallant in a press release.

Whether you’re a primary care physician, specialist, or rural provider, few diagnostic tools exist in your medical bag when it comes to spotting newcomers like psoriatic arthritis. While elevated A1C levels help you diagnose and treat diabetes, with psoriatic arthritis there are no labs to confirm your suspicions about patients with it.

“Most of the diagnosing is done visually and with x-ray,” says Beranek. Some people report skin problems, but not all, and others report both skin and joint problems simultaneously.

Some people also reported dactylitis and enthesitis symptoms, according to the MAPP survey.

Often, people develop a mild case of psoriasis and think nothing of it, says Beranek. “They never mention it to their physician or dermatologist. So it’s easy to imagine how we miss a diagnosis. Now add diminishing time spent with patients and it becomes the perfect storm.”

Make a better diagnosis with three simple questions

A good diagnosis blends art with science. It’s normal to feel some aches and pains in midlife. So you would expect to see sore joints in aging patient populations. But when they present with psoriasis and achy joints, Beranek says it’s worth paying attention to.

Consider asking patients:

• Do you feel stiffness in the morning?
• Do you notice swelling in your joints?
• Do you also have itchy, flaky, or scaly skin?

Other PsA symptoms include:

• Nail bed lifting
• Eye redness or pain

Visit the NPF to learn more.