Early psoriatic arthritis: clinical and therapeutic challenges.

ABSTRACT

Introduction

Psoriatic arthritis (PsA) is a chronic immunoinflammatory disease of the enthesis and adjacent synovium, skin, and nail, which early diagnosis may be crucial for starting a prompt therapeutic intervention. Theoretically, early treatment offers the advantage of acting on the reduction of the articular damage progression since initial phases of the disease.

Areas covered

This review explores the challenges of clinical-diagnostic aspects and the underlying pathophysiology of early PsA phases, as well as the evidence evaluating the impact of early intervention on disease outcomes.

Expert opinion

Main instruments for early PsA diagnosis include recognizing synovial-entheseal inflammatory signs at onset, improving screening PsA high-risk subjects, and increasing disease knowledge of physicians and patients with psoriasis or familial history.

PsA continues to significantly impact on the Quality of Life of patients affected by the disease, making necessary to deeply study clinical manifestations, risk factors and underlying immunoinflammatory mechanisms, as well as to identify biomarkers for early identification. Additionally, it remains a need to increase more evidence on understanding how early treatment of PsA and of psoriasis might influence the course of the disease.

KEYWORDS:

• Early psoriatic arthritis
• Treat-to-target
• bDMARDs
• JAK-inhibitors
• methotrexate
• PsA risk factors

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed they have participated as PI/SI and/or advisor and/or invited speaker for Abbvie, Gebro, Leo-Pharma, Novartis, Janssen, UCB, BI, BMS, Lilly, Sandoz, Almirall. A second reviewer has disclosed they have research grants from Pfizer, AbbVie, Sandoz. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Article highlights

• Psoriatic arthritis (PsA) is a chronic immunoinflammatory disease, which early diagnosis may be crucial for starting a prompt therapy able to block progression of the structural damage and improve clinical outcomes.

• Main instruments for early PsA diagnosis include recognizing synovialentheseal inflammatory signs at onset, improving screening PsA highrisk subjects, and increasing disease knowledge of physicians and patients with psoriasis or its family history.

• No laboratory biomarkers have been identified as specifically diagnostic for PsA, but ultrasound and magnetic resonance imaging of painful synovioentheseal sites represent supportive instrumental tools, particularly for detecting the early presence of active inflammation.

• Theoretically, early PsA therapy offers the advantage of acting on the reduction of the articular damage progression since initial phases of the disease.

• It remains a need to collect more evidence on understanding how early treatment of PsA and of psoriasis might influence the course of the disease.

Additional information

Funding

This paper was not funded.