Psoriasis and Psoriatic Arthritis: Don’t Miss the Diagnosis

At the Masterclasses in Dermatology APP Institute, Dr Joseph Merola and Dr Alice Gottlieb urged dermatology providers to sharpen their clinical lens for psoriatic arthritis (PsA) in their case-based session, “Screening and Interactive Cases.”

Dermatologists are often the first—and best—line of defense in identifying PsA early, well before irreversible joint damage sets in. “Cutaneous disease can precede arthritis by 10 to 12 years,” Dr Gottlieb emphasized, pointing to the critical window dermatologists have to intervene.

Up to 41% of PsA cases go undiagnosed, they noted, despite clear warning signs. To simplify screening, they introduced the “PsA mnemonic:” Pain, Stiffness, Swelling, Axial involvement. Providers should also use tools like the Psoriasis Epidemiology Screening Tool (PEST) and the Psoriatic Arthritis Impact of Disease questionnaire (PsAID)-12 regularly in clinical workflows.

Dr Gottlieb highlighted the power of integrating these tools into the electronic health record (EHR): “If a PEST score is ≥3, a drop-down alerts you with one click to rheumatology referral and shows US Food and Drug Administration-approved PsA drugs.” This simple workflow shift led to early identification and improved outcomes in thousands of patients across their health care system.

Through real-world vignettes, Drs Merola and Gottlieb presented cases and challenged the audience to make decisions in scenarios that mirrored everyday practice:

• A 58-year-old with plaque psoriasis and joint pain scores a PEST of 3 and PsAID of 5. What next?
• A 39-year-old woman with diagnosed PsA reports gastrointestinal upset from nonsteroidal anti-inflammatory drugs and poor control. Is it time to change biologics?
• A 35-year-old with Crohn’s disease and paradoxical psoriasis is on infliximab. What are the right next steps when symptoms persist?

Each case offered a nuanced discussion of treatment by disease domain—skin, joints, axial symptoms, and comorbidities—with references to the latest trial data and American Academy of Dermatology-National Psoriasis Foundation guidelines.

“It is essential in the treatment of psoriasis to know first if the patient also has PsA,” Dr Merola stated.

With user-friendly tools, EHR prompts, and a proactive mindset, APPs are well-positioned to spot PsA before it silently steals function. Attendees left empowered to screen with confidence and change lives by doing so.

Reference

Gottlieb A, Merola J. Screening and interactive cases. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.