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How Can Psoriatic Arthritis Be Diagnosed Early?

  • PSORIATIC ARTHRITIS (O FITZGERALD AND P HELLIWELL, SECTION EDITORS)
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Abstract

Psoriatic arthritis (PsA) is an inflammatory arthritis that usually develops after the onset of cutaneous psoriasis. Early diagnosis of PsA may lead to less joint damage and better long-term outcomes. Identifying inflammatory arthritis in individuals with psoriasis is the key to early diagnosis of PsA. Screening strategies targeted at individuals with psoriasis, as well as family members of patients with PsA will result in early identification of PsA. This article describes the various strategies that could be employed to identify inflammatory arthritis in patients with psoriasis so that appropriate referral to a rheumatologist for early diagnosis of PsA may be made.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Wright V, Moll JMH. Psoriatic arthritis. In Seronegative polyarthritis. North Holland Publishing Co. 1976: 169–223.

  2. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665–73.

    Article  PubMed  Google Scholar 

  3. Chandran V, Schentag CT, Gladman DD. Sensitivity of the classification of psoriatic arthritis criteria in early psoriatic arthritis. Arthritis Rheum. 2007;57:1560–3.

    Article  PubMed  Google Scholar 

  4. Chandran V, Raychaudhuri SP. Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. J Autoimmun. 2010;34:J314–21.

    Article  PubMed  CAS  Google Scholar 

  5. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005;64 Suppl 2:ii14–7.

    Google Scholar 

  6. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, Stern RS, Feldman SR, Rolstad T. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol. 2005;53:573.

    Article  PubMed  Google Scholar 

  7. Ibrahim G, Waxman R, Helliwell PS. The prevalence of psoriatic arthritis in people with psoriasis. Arthritis Rheum. 2009;61:1373.

    Article  PubMed  CAS  Google Scholar 

  8. Gladman DD. Natural history of psoriatic arthritis. Baillieres Clin Rheumatol. 1994;8:379–94.

    Article  PubMed  CAS  Google Scholar 

  9. Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK. Psoriatic arthritis (PSA)—an analysis of 220 patients. Q J Med. 1987;62:127–41.

    PubMed  CAS  Google Scholar 

  10. Gladman DD, Stafford-Brady F, Chang CH, Lewandowski K, Russell ML. Longitudinal study of clinical and radiological progression in psoriatic arthritis. J Rheumatol. 1990;17:809–12.

    PubMed  CAS  Google Scholar 

  11. Kane D, Stafford L, Bresnihan B, FitzGerald O. A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford). 2003;42:1460–8.

    Article  CAS  Google Scholar 

  12. Poole CD, Lebmeier M, Ara R, Rafia R, Currie CJ. Estimation of health care costs as a function of disease severity in people with psoriatic arthritis in the UK. Rheumatology (Oxford). 2010;49:1949–56.

    Article  Google Scholar 

  13. Wong K, Gladman DD, Husted J, Long J, Farewell VT. Mortality studies in psoriatic arthritis. Results from a single centre. I. Risk and Causes of Death. Arthritis Rheum. 1997;40:1873–7.

    Article  Google Scholar 

  14. Ali Y, Tom BDM, Schentag CT, Farewell VT, Gladman DD. Improved survival in psoriatic arthritis (PsA) with calendar time. Arthritis Rheum. 2007;56:2708–14.

    Article  PubMed  Google Scholar 

  15. Gladman DD, Farewell VT, Wong K, Husted J. Mortality studies in psoriatic arthritis. Results from a single centre. II. Prognostic factors for death. Arthritis Rheum. 1998;41:1103–10.

    Article  PubMed  CAS  Google Scholar 

  16. Gladman DD. Disability and quality of life considerations. Psoriatic arthritis. In: Gordon GB, Ruderman E, editors. Psoriasis and psoriatic arthritis: an integral approach. Heidelberg: Springer-Verlag; 2005. p. 118–23.

    Chapter  Google Scholar 

  17. • Gladman DD, Thavaneswaran A, Chandran V, Cook RJ. Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? Ann Rheum Dis. 2011;70:2152–4. Disease progression is more marked in patients presenting with established disease of more than 2 years’ duration. These results suggest that patients with PsA should be treated earlier in the course of their disease.

    Article  PubMed  Google Scholar 

  18. Radtke MA, Reich K, Blome C, Rustenbach S, Augustin M. Prevalence and clinical features of psoriatic arthritis and joint complaints in 2009 patients with psoriasis: results of a German national survey. J Eur Acad Dermatol Venereol. 2009;23:683–91.

    Article  PubMed  CAS  Google Scholar 

  19. Reich K, Krüger K, Mössner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol. 2009;160:1040–7.

    Article  PubMed  CAS  Google Scholar 

  20. • Christophers E, Barker JN, Griffiths CE, Daudén E, Milligan G, Molta C, Sato R, Boggs R. The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics. J Eur Acad Dermatol Venereol. 2010;24:548–54. In contrast to the prevailing notion that the greatest risk of developing PsA is during the first years following the onset of psoriasis, this retrospective report from Europe has shown that the rate of development of PsA among psoriasis patients is constant and unrelated to the duration of psoriasis.

    Article  PubMed  CAS  Google Scholar 

  21. • Eder L, Chandran V, Shen H, Cook RJ, Shanmugarajah S, Rosen CF, Gladman DD. Incidence of arthritis in a prospective cohort of psoriasis patients. Arthritis Care Res (Hoboken). 2011;63:619–22. In contrast to the prevailing notion that the greatest risk of developing PsA is during the first years following the onset of psoriasis, this prospective report has shown that the rate of development of PsA among psoriasis patients is constant and unrelated to the duration of psoriasis.

    Article  Google Scholar 

  22. • Chandran V, Schentag CT, Brockbank JE, Pellett FJ, Shanmugarajah S, Toloza SM, Rahman P, Gladman DD. Familial aggregation of psoriatic arthritis. Ann Rheum Dis. 2009;68:664–7. An increase in risk of developing PsA in first-degree relatives of patients with PsA indicates that targeted screening of family members is a strategy for early diagnosis.

    Article  PubMed  CAS  Google Scholar 

  23. • Karason A, Love TJ, Gudbjornsson B. A strong heritability of psoriatic arthritis over four generations—the Reykjavik Psoriatic Arthritis Study. Rheumatology (Oxford). 2009;48:1424–8. An increase in risk of developing PsA in first- to fourth-degree relatives of patients with PsA indicates that targeted screening of family members is a strategy for early diagnosis.

    Article  Google Scholar 

  24. Chandran V, Gladman DD. Update on biomarkers in psoriatic arthritis. Curr Rheumatol Rep. 2010;12:288–94.

    Article  PubMed  CAS  Google Scholar 

  25. Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009;61:233–9. Erratum in: Arthritis Rheum 2010;62:574.

    Article  PubMed  CAS  Google Scholar 

  26. Dominguez P, Gladman DD, Helliwell P, Mease PJ, Husni ME, Qureshi AA. Development of screening tools to identify psoriatic arthritis. Curr Rheumatol Rep. 2010;12:295–9.

    Article  PubMed  Google Scholar 

  27. Khraishi M, Mong J, Mugford G, Landells I. The electronic Psoriasis and Arthritis Screening Questionnaire (ePASQ): a sensitive and specific tool to diagnose psoriatic arthritis patients. J Cutan Med Surg. 2011;15:143–9.

    PubMed  Google Scholar 

  28. Husni ME, Meyer KH, Cohen DS, Mody E, Qureshi AA. The PASE questionnaire: pilot-testing a psoriatic arthritis screening and evaluation tool. J Am Acad Dermatol. 2007;57:581–7.

    Article  PubMed  Google Scholar 

  29. Dominguez PL, Husni ME, Holt EW, Tyler S, Qureshi AA. Validity, reliability, and sensitivity-to-change properties of the psoriatic arthritis screening and evaluation questionnaire. Arch Dermatol Res. 2009;301:573–9.

    Article  PubMed  Google Scholar 

  30. Ibrahim GH, Buch MH, Lawson C, Waxman R, Helliwell PS. Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire. Clin Exp Rheumatol. 2009;27:469–74.

    PubMed  CAS  Google Scholar 

  31. Gladman DD, Schentag CT, Tom BD, Chandran V, Brockbank J, Rosen C, Farewell VT. Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (ToPAS). Ann Rheum Dis. 2009;68:497–501.

    Article  PubMed  CAS  Google Scholar 

  32. Chandran V. The genetics of psoriasis and psoriatic arthritis. Clin Rev Allergy Immunol 2012;Jan 25. [Epub ahead of print] PubMed PMID: 22274791.

  33. • Eder L, Chandran V, Pellet F, Shanmugarajah S, Rosen CF, Bull SB, Gladman DD. Human leucocyte antigen risk alleles for psoriatic arthritis among patients with psoriasis. Ann Rheum Dis. 2012;71:50–5. HLA-B*08, -B*27, -B*38, and HLA-C*06 alleles confer susceptibility to PsA among patients with psoriasis and may be used to identify patients with PsC who may develop PsA.

    Article  PubMed  Google Scholar 

  34. • Winchester R, Minevich G, Steshenko V, Kirby B, Kane D, Greenberg DA, Fitzgerald O. HLA associations reveal genetic heterogeneity in psoriatic arthritis and in the psoriasis phenotype. Arthritis Rheum 2011. doi:10.1002/art.33415. Patients with PsA carrying the HLA-B*27 allele have temporally more coincident musculoskeletal disease. HLA-B*08, -B*27, and HLA-C*06 alleles confer susceptibility to PsA among patients with psoriasis and may be used to identify patients with PsC who may develop PsA.

  35. Nair RP, Duffin KC, Helms C, Ding J, Stuart PE, Goldgar D, Gudjonsson JE, Li Y, Tejasvi T, Feng BJ, Ruether A, Schreiber S, Weichenthal M, Gladman D, Rahman P, Schrodi SJ, Prahalad S, Guthery SL, Fischer J, Liao W, Kwok PY, Menter A, Lathrop GM, Wise CA, Begovich AB, Voorhees JJ, Elder JT, Krueger GG, Bowcock AM, Abecasis GR. Collaborative Association Study of Psoriasis. Genome-wide scan reveals association of psoriasis with IL-23 and NF-kappaB pathways. Nat Genet. 2009;41:199–204.

    Article  PubMed  CAS  Google Scholar 

  36. Gladman DD, Chandran V. Review of clinical registries of psoriatic arthritis: lessons learned?: value for the future? Curr Rheumatol Rep. 2011;13:346–52.

    Article  PubMed  Google Scholar 

  37. Tam LS, Tomlinson B, Chu TT, Li M, Leung YY, Kwok LW, et al. Cardiovascular risk profile of patients with psoriatic arthritis compared to controls—the role of inflammation. Rheumatology (Oxford). 2008;47:718–23.

    Article  Google Scholar 

  38. Strober B, Teller C, Yamauchi P, Miller JL, Hooper M, Yang YC, Dann F. Effects of etanercept on C-reactive protein levels in psoriasis and psoriatic arthritis. Br J Dermatol. 2008;159:322–30.

    Article  PubMed  CAS  Google Scholar 

  39. Alenius GM, Eriksson C, Rantapää Dahlqvist S. Interleukin-6 and soluble interleukin-2 receptor alpha-markers of inflammation in patients with psoriatic arthritis? Clin Exp Rheumatol. 2009;27:120–3.

    PubMed  Google Scholar 

  40. Chandran V, Cook RJ, Edwin J, Shen H, Pellett FJ, Shanmugarajah S, Rosen CF, Gladman DD. Soluble biomarkers differentiate patients with psoriatic arthritis from those with psoriasis without arthritis. Rheumatology (Oxford). 2010;49:1399–405.

    Article  CAS  Google Scholar 

  41. Ritchlin CT, Haas-Smith SA, Li P, Hicks DG, Schwarz EM. Mechanisms of TNF-alpha- and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis. J Clin Invest. 2003;111:821–31.

    PubMed  CAS  Google Scholar 

  42. • Chiu YG, Shao T, Feng C, Mensah KA, Thullen M, Schwarz EM, Ritchlin CT. CD16 (FcRgammaIII) as a potential marker of osteoclast precursors in psoriatic arthritis. Arthritis Res Ther. 2010;12:R14. CD16 has the potential to serve as a marker for osteoclast precursors in inflammatory arthritis.

    Article  PubMed  Google Scholar 

  43. McGonagle D, Lories RJ, Tan AL, Benjamin M. The concept of a “synovio-entheseal complex” and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum. 2007;56:2482–91.

    Article  PubMed  Google Scholar 

  44. Erdem CZ, Tekin NS, Sarikaya S, et al. MR imaging features of foot involvement in patients with psoriasis. Eur J Radiology. 2008;68:521–5.

    Article  Google Scholar 

  45. Gisondi P, Tinazzi I, El-Dalati G, et al. Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case-control study. Ann Rheum Dis. 2008;67:26–30.

    Article  PubMed  CAS  Google Scholar 

  46. Raza N, Hameed A, Ali MK. Detection of subclinical joint involvement in psoriasis with bone scintigraphy and its response to oral methotrexate. Clin Exp Dermatol. 2008;33:70–3.

    Article  PubMed  CAS  Google Scholar 

  47. Tan AL, Grainger AJ, Taneer SF, Emery P, Mcgonagle D. A high resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthritis Rheum. 2006;54:1328–33.

    Article  PubMed  Google Scholar 

  48. Bennett AN, Rehman A, Hensor EM, Marzo-ortega H, Emery P, Mcgonagle D. Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondyloarthritis. Arthritis Rheum. 2009;60:1331–41.

    Article  PubMed  CAS  Google Scholar 

  49. • Tinazzi I, McGonagle D, Biasi D, Confente S, Caimmi C, Girolomoni G, Gisondi P. Preliminary evidence that subclinical enthesopathy may predict psoriatic arthritis in patients with psoriasis. J Rheumatol. 2011;38:2691–2. This follow-up study indicates that patients with psoriasis who have higher enthesopathy score may be at higher risk of developing PsA.

    Article  PubMed  Google Scholar 

  50. • Ash ZR, Tinazzi I, Gallego CC, Kwok C, Wilson C, Goodfield M, Gisondi P, Tan AL, Marzo-Ortega H, Emery P, Wakefield RJ, McGonagle DG, Aydin SZ. Psoriasis patients with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than those with normal nails. Ann Rheum Dis. 2012;71:553–6. A link between nail disease and contemporaneous subclinical enthesopathy offers a novel anatomic basis for the predictive value of nail psoriasis for PsA evolution.

    Article  PubMed  Google Scholar 

  51. Mandl P, Niedermayer DS, Balint PV. Ultrasound for enthesitis: handle with care! Ann Rheum Dis. 2012;71:477–9.

    Article  PubMed  Google Scholar 

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Disclosure

Dr. Haddad is supported by a grant from Merck Frosst Canada.

Dr. Chandran is supported by a New Emerging Team grant for the International Psoriasis and Arthritis Research Team(IPART)/CIHR Team in Psoriasis and Psoriatic Arthritis from the Canadian Institutes of Health Research.

The University of Toronto psoriatic arthritis program is supported by the Krembil Foundation.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada

    Amir Haddad

  2. Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, Canada

    Amir Haddad

  3. Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada

    Vinod Chandran

  4. Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, 1E 416, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada

    Vinod Chandran

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  1. Amir Haddad
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  2. Vinod Chandran
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Correspondence to Vinod Chandran.

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Haddad, A., Chandran, V. How Can Psoriatic Arthritis Be Diagnosed Early?. Curr Rheumatol Rep 14, 358–363 (2012). https://doi.org/10.1007/s11926-012-0262-6

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