PracticeUpdate Conference Series World Congress of Dermatology 2019

Psoriatic Arthritis Expert Implores Dermatologists to Become More Involved in This Condition They are in the best position to facilitate early diagnosis, rapid access to effective therapy.

D ermatologists are ideally positioned to eval- uate high-risk patients for psoriatic arthritis and ensure that they obtain timely therapy, according to a presentation at WCD 2019. The presentation also highlighted the latest advances in the treatment of this condition. “Psoriatic arthritis is disabling, and delays in diagno- sis increase disability and pain,” emphasized Alice Gottlieb, MD, PhD, of New York Medical College during her presentation. The presence of psoriasis is an important risk factor for psoriatic arthritis, she explained. In fact, 84% of patients with psoriatic arthritis had psoriasis for an average of 10 to 12 years before they developed the condition. “In America, the [American Academy of Derma- tology] AAD guidelines for psoriasis care have come out to say that patients with psoriasis should be informed about the association [between pso- riasis and psoriatic arthritis] because they don’t [necessarily] know that their pain is associated with their psoriasis,” she continued. “Psoriatic arthritis should be considered in all patients with cutaneous psoriasis. I really feel strongly about this. It’s not just the moder- ate-to-severe [cases]. I’ve had patients come to joint replacement where the only psoriasis I could find was a little on the scalp. Patients who have signs and symptoms suspicious of psoriatic arthritis should be fully evaluated and treatment initiated, if not by the dermatologist, then the rheumatologist. So, it’s important to be sensitive to the diagnosis.” Early diagnosis is particularly important, given there are multiple effective therapies that not only control the signs and symptoms of the disease but have also been shown to inhibit radiographic progres- sion and improve quality of life. “The first people who can start treatment or get them to a rheuma- tologist is the dermatologist,” said Dr. Gottlieb. With the advent of effective biologic therapies for psoriatic arthritis, the role of methotrexate is

diminishing. For instance, the SEAM-PsA study randomized patients with active psoriatic arthritis to methotrexate monotherapy, etanercept mono- therapy, or a combination of both. Etanercept was more effective than methotrexate. “The addition of methotrexate to etanercept did not make a difference, so you can treat psoriatic arthritis with monotherapy,” concluded Dr. Gottlieb about this study. “The American College of Rheumatology [ACR] recommends a TNF-blocker over anything else as first-line for psoriatic arthritis, which is a big change,” she continued. “… If you’re looking at evidence-based medicine, TNF-blockers should be given ahead of methotrexate. However, I would still posit that they are behind the times. … I believe that both [the interleukin (IL)-17 inhibitors] ixekizumab and secukinumab should be first-line of psoriatic arthritis, in the absence of inflammatory bowel disease, because they inhibit radiographic progression in addition to controlling signs and symptoms. … They work as well in the joints, they work better in the skin than the TNF-blockers, and [they are] even safer.”

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PRACTICEUPDATE CONFERENCE SERIES • WCD 2019