A Joint Consensus of Rheumatologists and Dermatologists on Early Detection and Effective Management of Psoriatic Arthritis: India's Perspective

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory disease with clinical manifestations, including inflammatory arthritis and the presence of psoriasis (PsO). The present consensus statement evaluated the early diagnosis and treatment approaches in the management of psoriasis and psoriatic arthritis by rheumatologists and dermatologists. For PAN India representation, a panel of eight rheumatologists and five dermatologists from different institutes in India were constituted. These thirteen experts were divided into two groups (rheumatologists group and dermatologist group) who received a set of questionnaires each for diagnosis and treatment approaches in the management of psoriasis and psoriatic arthritis. Based on the responses received, a panel discussion took place, where the experts identified the early diagnostic criteria for PsA considering: Clinical signs and symptoms, and questionnaire-based PsA screening, which includes Psoriasis Epidemiology Screening Tool (PEST) for dermatologists and Classification Criteria for Psoriatic Arthritis (CASPAR) for rheumatologists. The experts also recommended shift from conventional disease-modifying anti-rheumatic drugs (DMARDs) to biologics like secukinumab, when there is extensive skin involvement and TNF inhibitors when there is extensive joint involvement. Overall, the objective of the consensus was to assist rheumatologists and dermatologists in the early diagnosis and management of patients of PsA and PsO in their clinical practice.

Keywords: Classification criteria for psoriatic arthritis; psoriasis epidemiology screening tool; psoriatic arthritis.

Figure 1

Flow chart showing methodology and objective

Figure 2

Brief recommendations (from meeting excerpts): Patient presentation and early diagnosis of psoriasis and psoriatic arthritis (PsA: Psoriatic Arthritis, CASPAR: Classification Criteria for Psoriatic Arthritis)

Figure 3

GRAPPA Management recommendations[16] (GRAPPA: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, NSAID: Non-steroid anti-inflammatory drugs, IA DMARDs: Intra-Articular Disease-Modifying Anti-Rheumatic Drugs, MTX: Methotrexate, CsA: Cyclosporine A, SSZ: Sulfasalazine, LEF: Leflunomide, Anti-TNF: Anti-Tissue Necrosis Factor)

Figure 4

EULAR Management recommendations.[16] (a) Phase I, (b) Phase II, (c) Phase III (EULAR: European League Against Rheumatism, DMARDs: Disease-Modifying Anti-Rheumatic Drugs, MTX: Methotrexate, TNF: Tissue Necrosis Factor)

Figure 5

Brief Recommendations (from meeting excerpts): Treatment approaches in the management of psoriasis and psoriatic arthritis (PsO: Psoriasis, PsA: Psoriatic Arthritis, DMARDs: Disease-Modifying Anti-Rheumatic Drugs, IBD: Inflammatory Bowel Disease, TB: Tuberculosis, TNF: Tissue Necrosis Factor)