How Different Psoriatic Arthritis Manifestations Affect Care

Christopher T. Ritchlin, MD, MPH: This was a conversation with Dr. Sergio Schwartzman from New York. We talked about how the complexity of the presenting symptoms in an individual patient can be so daunting even on the initial evaluation, because you can have, as I just previously mentioned, the 6 domains of involvement, and most patients have between 2-4 domains at one time. So, there's a complexity from the musculoskeletal and skin perspective. You can have different types of psoriasis, you can have different types of arthritis, and you can have combinations of these forms of joint inflammation: enthesitis, distal interphalangeal joint involvement, axial skeleton, other peripheral joints. You take that complexity, and then you add to it the comorbidities—diabetes, obesity, hypertension, metabolic syndrome, anxiety, depression—and it really makes for a very complex decision-making and evaluation process.

So, we talked about how this can be carried out in the office and in a reasonably efficient manner, and how important it is for us to be able to, on the initial evaluation, know exactly what a patient is dealing with from these different perspectives, so that you can have a conversation with them, share decision making, and come up with a treatment regimen that is safe and effective.