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On the Necessity of Early Detection for Psoriatic Arthritis

Psoriatic arthritis (PsA) affects close to 520,000 patients in the USA alone, while some figures suggest that 1-3% of the world’s population has been diagnosed with psoriasis itself.  
If dermatologist practitioners have clear enough vision to diagnose and treat PsA rapidly and appropriately, many patients might be saved from the potentially devastating long-term consequences of this disease.  In addition to this, early detection will reduce risks of mortality, cardiovascular disease and metabolic syndrome.  Understanding treatment guidelines, assessment tools and treatment issues can help assist dermatologists in limiting PsA patient risks.
The Skinny: Early Detection of PsA is Everything
In most clinical studies, it has been found that only one in seven patients feel the effects of PsA before the skin manifestation of psoriasis begins.  For most patients, PsA begins to occur 7-12 years before the actual diagnosis, and the likelihood of this diagnosis correlates with the duration of clinical psoriasis symptoms.  This puts the burden of diagnosis squarely on the dermatologist for early detection, particularly when cutaneous psoriasis is present.
The Psychological Effects 
It’s no surprise that patients suffering with PsA are profoundly impacted by the psychological effects of the disease.  Studies show a positive correlation between psoriasis-related conditions and use of psychiatric meds, level of alcohol consumption, and cirgarette use.  Likewise, similar reports show that between 5-20% of patients suffering from psoriasis have contemplated suicide.
If left untreated, a significant portion of patients with PsA will develop ongoing inflammation, leading to joint damage, severe functional limitations and disability.  Certain novel agents (although not yet approved PsA) may one day increase treatments available to patients with PsA.  These agents include ustekinumab and abatacept.  
Dermatologists and Derm PAs are urged to assess patients for all signs of PsA at each visit, given the potential long-term consequences of undiagnosed PsA.  Early detection is truly everything.
Source: Medscape
[image by C.P. Storm]

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