A Review for Physician Assistants and Nurse Practitioners on the Considerations for Diagnosing and Treating Psoriatic Arthritis

Abstract

Psoriatic arthritis (PsA) is a clinically heterogeneous form of progressive inflammatory arthritis that affects up to 30% of patients with psoriasis. The rapid rate of progression associated with PsA makes early-disease diagnosis and treatment crucial to patients' quality of life and long-term health. With the aim of providing clinical guidance to physician assistants and nurse practitioners, this article gives an overview of the different PsA clinical domains, including peripheral arthritis, axial disease, enthesitis, dactylitis, skin disease, and nail dystrophy, which should be considered as part of diagnosis and treatment strategies. The efficacy of different therapies across these PsA domains is reviewed within the context of current PsA treatment guidelines while considering more recent data on newly approved therapies for PsA.Funding: Novartis Pharmaceuticals Corp., East Hanover, NJ, USA.

Keywords: Comorbidities; Diagnosis; Nurse practitioner; Physician assistant; Psoriasis; Psoriatic arthritis.

Fig. 1

Clinical features of PsA. a Areas of the body affected by the different clinical domains of PsA. DIP distal interphalangeal, PIP proximal interphalangeal, GRAPPA Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, PsA psoriatic arthritis. b The hand of a patient with PsA [76]. Psoriatic lesions and the involvement of peripheral joints are indicative of PsA. Reproduced with permission from: dermnet.com

Fig. 2

GRAPPA treatment schema for active PsA* [14]. Reproduced with permission from: Coates LC, Kavanaugh A, Mease PJ, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheumatol. 2016;68:1060–71. *Light text identifies conditional recommendations for drugs that do not currently have regulatory approvals or for which recommendations are based on abstract data only

Fig. 3

a ACR20 and b PASI75 response rates reported at week 24 in phase 3 trials of targeted therapies approved for the treatment of active PsA [, , , , –71]. For agents without a dose specified, results are presented for the approved dosage. Figure is for visualization purposes only and should not be used to make direct comparisons of efficacy between therapies. ACR American College of Rheumatology, BID twice daily, IV intravenous, PASI Psoriasis Area Severity Index, PsA psoriatic arthritis, Q4W every 4 weeks, Q2W every 2 weeks, QW once weekly