Early Identification of axPsA

With the correct screening procedures for patients with psoriasis, performed in a timely manner, dermatologists can play an important role in identifying early signs of psoriatic arthritis (PsA) and more specifically axial psoriatic arthritis (axPsA), researchers reported. The findings of the study are published in the Annals of the Rheumatic Diseases.

“Early diagnosis of PsA (and axPsA in particular) is essential and dermatologists are in a strategic position to screen at-risk patients with psoriasis before advanced structural damage of the joints and spine appears,” the authors wrote. “Our study revealed that application of a dermatologist-centered screening tool focusing on identifying signs of axial involvement among patients with psoriasis may be useful for the detection of PsA (and specifically axPsA) in these patients.”

The researchers gathered data from adults with psoriasis, who had chronic back pain for more than 3 months, who started showing symptoms before they turned 45 years of age, and who were not receiving any biologic or targeted synthetic disease-modifying antirheumatic drug treatment for 12 weeks before the screening. All clinical, laboratory, and genetic assessments, along with conventional radiography imaging and magnetic resonance imaging of sacroiliac joints and spine, were included.

Out of 100 patients, the investigators found that 14 patients were diagnosed with axPsA and 5 were diagnosed with peripheral PsA solely. Among the patients with axPsA, the team found an interesting commonality – that all of them had active inflammatory and/or structural (post) inflammatory changes in the sacroiliac joints and/or spine on imaging. Furthermore, 5 patients showed axial involvement in the spine.

“The Assessment of SpondyloArthritis International Society criteria for axSpA were fulfilled in 9 (64.3%) patients diagnosed with axPsA,” the authors noted.

The prospective multicenter study highlighted the importance of a variety of screening and referral tools to identify peripheral manifestations of PsA as well as validate referral algorithms for axPsA.

A delayed diagnosis of axPsA may lead to irreversible joint and spinal damage and poor long-term outcomes. However, if dermatologists actively screen patients with psoriasis early on, it is possible to detect axPsA at its initial stages.

“The tool is easy to apply and not time-consuming, which makes its application feasible in daily practice ideally in combination with a screening for peripheral disease,” the authors concluded. “These results provide valuable real-world insights into the possibility of diagnosing axPsA early with the ultimate goal of improving the care and quality of life of patients living with the disease.”

—Priyam Vora

Reference:
Proft F, Luders S, Hunter T et al. Early identification of axial psoriatic arthritis among patients with psoriasis: a prospective multicentre study. Ann Rheum Dis. Published online August 3, 2022. DOI: 10.1136/ard-2022-222562