Efficient Screening for Psoriatic Arthritis

At the 2025 South Beach Symposium, Naiem Issa, MD, PhD, FAAD, a board-certified dermatologist with Forefront Dermatology in Vienna, Virginia, shared insights into the challenges of diagnosing and managing psoriatic arthritis in dermatology clinics. He emphasized the importance of efficient screening methods to identify patients at risk, given the often busy nature of dermatology practices.

Issa highlighted the significance of a holistic yet time-efficient approach, stating, "The hard thing is that we have a busy clinic, right? And to be holistic in the way we are treating our patients, but also being time efficient." He advised clinicians to conduct simple screenings by asking patients about joint pain, its duration, and specific locations of discomfort. He suggested that clinicians should also assess areas where tendons insert, as this may indicate early symptoms of psoriatic arthritis. "For example, I ask them a question, like, when you wake up in the morning, do you have any aches? And do they get better as you gel throughout the morning?" he explained. Such inquiries can help patients recognize symptoms they may not have otherwise considered significant.

In discussing risk factors, Issa pointed out that individuals with nail psoriasis, inverse psoriasis, and scalp psoriasis are at a higher likelihood of developing psoriatic arthritis. However, he cautioned that all psoriasis patients should be evaluated for joint involvement. "Everybody has the potential to have arthritis right, beyond just those special sites, and at least ask them the question, and then take it from there, right?" he emphasized.

Issa also addressed the evolving landscape of treatment, particularly regarding the potential for a remittive effect in psoriasis and psoriatic arthritis management. While current medications typically require long-term use, emerging data suggest that higher dosing strategies may offer longer disease remission. He referenced a study on IL-23 inhibition, noting, "For example, there’s a study that showed that for IL-23 inhibition called the Knockout study, where you are using high dose of an induction dose with a loading dose, you may be knocking out the memory T cells that give rise to future disease." However, he acknowledged that these findings are still in their infancy.

Regarding treatment selection, Issa discussed the role of different therapeutic pathways, including IL-17 and IL-23 inhibitors, as well as the potential for TYK2 inhibitors to bridge these mechanisms. He highlighted the advantages of TYK2 inhibitors, stating, "The beauty of the molecule that currently exists, deucravacitinib for TYK2 inhibition, is that it’s a small molecule, so it has fast on and off. That gives you a lot of creativity in how you want to use that for certain patient populations."

Issa concluded by underscoring the importance of early intervention. Research indicates that treating psoriasis early, before joint pain develops, may reduce the likelihood of psoriatic arthritis onset. While more studies are needed, he emphasized the value of proactive screening and treatment to improve patient outcomes.