Despite unknowns, future holds potential for psoriatic disease

MAUI, HAWAII — Though approximately 25% of patients with psoriasis will eventually develop psoriatic arthritis, it remains unclear which patients will, according to a presentation here at Maui Derm for Dermatologists 2020.

“We don't know for sure who these patients are,” Arthur Kavanaugh, MD, professor of medicine, University of California San Diego, told attendees. “But we know that for about 85% of patients with psoriasis, the onset of psoriatic arthritis occurs in about 10 years.”

He said that a limited number of answers have begun to emerge.

“Researchers in Canada that studied patients with both conditions found that about 4 years before the psoriatic arthritis conversion, they started to see some differences in the genomic sequencing and a variety of epigenetic changes. But there's not anything from this research that we can take to the clinic yet,” Kavanaugh said. “Most teams that define people with psoriatic arthritis are already in the early stages of it. But something like a test that could predict these patients ahead of time could be coming.”

He noted that the evidence is slightly clearer on the comorbidities that some of these patients will experience. These conditions include axial arthritis, bad tendonitis, enthesitis, dactylitis, inflammatory bowel disease, obesity, metabolic syndrome and cardiovascular events, among others, according to Kavanaugh.

Dermatologists should consider this wide range of diseases as they consider treatments for patients with psoriatic arthritis, Kavanaugh continued.

“Most of the people with both psoriasis and psoriatic arthritis have three or more diseases going on,” he said. “The way to get someone in remission is to get them feeling as well as they possibly could across all these domains.”

He added that the next decade holds a lot of potential in this clinical area.

“When we come back to this meeting in 5 years, 10 years, hopefully we'll know so much more. This could be really fascinating to keep an eye on,” Kavanaugh said. – by Janel Miller

Reference: Kavanaugh A. Psoriatic arthritis. Presented at: Maui Derm for Dermatologists; Jan. 25-29, 2020; Maui, Hawaii.

Disclosures: Kavanaugh reports professional relationships with 18 different companies or organizations including AbbVie and Amgen.