Inflammatory Arthritis for the Dermatologist: Screening and Diagnosing Psoriatic Arthritis

Dr. Alice Gottlieb presents insights on the importance of screening for psoriatic arthritis (PsA) in dermatology, highlighting that about 25% of psoriasis patients also experience PsA—a common yet often missed comorbidity by dermatologists. She emphasizes that detection is crucial, as delays in diagnosis can lead to irreversible disability due to the nature of the disease, where skin symptoms may precede joint symptoms by an average of ten years. Dr. Gottlieb discusses the necessity of thorough patient inquiries, regardless of the severity of skin conditions, and introduces screening tools, such as the PsA screening tool (PEST) and the PsA impact questionnaire (P-SET), that can be used to identify at-risk patients more effectively. She notes the prevalence of PsA among patients with mild psoriasis and identifies clinical features of PsA, including enthesitis and dactylitis, which may not initially present as obvious swelling or joint pain. With data reflecting her system-wide implementation at Mount Sinai, she cites a significant detection rate enhancement and advocates for dermatologist responsibility in early diagnosis and referral to rheumatology, presenting an algorithmic approach that simplifies the screening process and empowers patients to participate in their care. Dr. Gottlieb ends with a call to action for dermatologists to embrace these screening processes to improve patient outcomes.