Practically speaking, there are a couple of key lessons from the relationship between skin and joint involvement in psoriatic arthritis — the importance of detection of psoriatic arthritis if you have psoriasis, and the importance of taking skin symptoms into account when deciding on treatment.
“Skin symptoms can strongly influence treatment choice,” says Husni. “Severe psoriasis, nail disease, or difficult sites such as the scalp, palms, soles, or genitals may favor therapies with strong skin efficacy” that also target joint inflammation.
Dr. Ruderman says that when choosing a biologic drug, in many cases, “If you’re trying to get control of the skin, you pick the drug that’s going to best control the skin without so much worrying about what’s going to happen in the joints. Because most of them will work pretty well in the joints.” But in some cases, he says, a drug can adequately control skin disease but not joint disease. “So then you might have to switch over and try a different biologic.”
Above all, Ruderman says, it’s important to make sure all aspects of a person’s psoriatic arthritis are accounted for in treatment decisions. “It really does become a conversation with the rheumatologist, the dermatologist, and the patient to try to find the best targeted treatment that’s going to manage all of the symptoms that bother them,” he says.
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