05.01.2020
Findings may point to an opportunity for earlier diagnosis of PsA
by Judith Lin, MD
Psoriatic arthritis can be difficult to diagnose in early stages of symptom onset due to the variable clinical presentation, limited exam findings, overlapping features with other diseases, and lack of reliable biomarkers.
Perhaps it is not too surprising that a study published in Arthritis Care & Research by Lihi Eder and colleagues suggests a prodromal phase of psoriatic arthritis during which patients with this disease are more likely to have nonspecific musculoskeletal symptoms and visits to their primary care physicians or emergency department compared with matched comparators prior to diagnosis. More importantly, over a third of patients with psoriatic arthritis presented with musculoskeletal symptoms as early as 5 years before they were diagnosed. The significant time lapse from symptom onset to diagnosis may lead to a delay in treatment, an increase in healthcare burden and costs, and potentially may affect patient outcomes.
The study highlights the need for improvement in the understanding and recognition of psoriatic arthritis. Potential biomarkers in the form of inflammatory cytokines and genetic risk variants may help to identify those at risk for psoriatic arthritis. Musculoskeletal ultrasound can also confirm the presence of synovitis, tenosynovitis, or enthesitis, and may help to decrease time to diagnosis.
In the study population, over half of the patients with psoriatic arthritis had skin psoriasis — a known risk factor. Psoriatic arthritis may be underrecognized in patients who do not already have existing skin psoriasis. I find the CASPAR classification criteria for psoriatic arthritis to be helpful and easy to use in the clinical setting.
While better understanding of the disease pathogenesis and more reliable biomarkers are needed, raising awareness of the existing screening tools and risk factors may help improve the recognition of psoriatic arthritis among primary care physicians and allow for earlier referral and evaluation by a rheumatologist.
Judith Lin, MD, is assistant professor of medicine at Ohio State University, Wexner Medical Center, in Columbus.
You can read an interview with the lead author of this study here and an abstract of the study here.
Primary Source