Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA.
Department of Medicine, Division of Rheumatology and Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Dermatolog Treat. 2020 Nov;31(7):662-679. doi: 10.1080/09546634.2019.1605142. Epub 2019 May 7.
Psoriatic arthritis (PsA) affects up to one-third of patients with psoriasis. It is the major comorbidity of psoriasis because of the likelihood that loss of function and permanent disability will develop if initiation of treatment is delayed. Dermatologists are uniquely positioned to recognize early signs of PsA and be the first-line healthcare practitioners to detect PsA in patients with psoriasis. PsA can affect six clinical domains: peripheral arthritis, dactylitis, enthesitis, psoriasis, psoriatic nail disease, and axial disease. However, not every patient will have involvement of all domains and the domains affected can change over time. Complicating the diagnosis is the condition's similarity with other arthritic diseases and potential heterogeneity. In this article, we provide practical guidance for dermatologists for detecting PsA in patients with psoriasis. We also review the available treatment options by each clinical domain of PsA and give advice on how to interpret the results of PsA clinical trials. Through early recognition of PsA in patients with psoriasis and initiation of proper treatment, dermatologists can help to prevent PsA disease progression, irreversible joint damage, and resultant permanent disability, and improve quality of life.
银屑病关节炎（PsA）影响多达三分之一的银屑病患者。由于如果延迟治疗，功能丧失和永久性残疾的可能性增加，因此它是银屑病的主要合并症。皮肤科医生具有独特的优势，可以识别出 PsA 的早期迹象，并成为在银屑病患者中检测出 PsA 的一线医疗保健从业者。PsA 可影响六个临床领域：外周关节炎、指（趾）炎、附着点炎、银屑病、银屑病甲病和中轴疾病。然而，并非每个患者都会出现所有领域的受累，而且受累的领域也会随时间而变化。使诊断复杂化的是该疾病与其他关节炎性疾病的相似性以及潜在的异质性。在本文中，我们为皮肤科医生提供了在银屑病患者中检测 PsA 的实用指南。我们还回顾了每个 PsA 临床领域的可用治疗选择，并就如何解释 PsA 临床试验的结果提供了建议。通过早期识别银屑病患者中的 PsA 并进行适当的治疗，皮肤科医生可以帮助预防 PsA 疾病进展、不可逆性关节损伤和由此导致的永久性残疾，并提高生活质量。
