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Nat Rev Rheumatol. 2009 Nov;5(11):634-41. doi: 10.1038/nrrheum.2009.210. Epub 2009 Oct 6.

The diagnosis and treatment of early psoriatic arthritis.

Author information

1
Clinical Immunology Research Center, Allergy, Immunology & Rheumatology Research Division, University of Rochester Medical Center, 601 Elmwood Avenue, P. O. Box 695, Rochester, NY 14642, USA. allen_anandarajah@urmc.rochester.edu

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder associated with a heterogeneous disease presentation, varied disease expression and an unpredictable but often chronically destructive clinical course. Joint damage can occur early in the disease; indeed, several imaging modalities have demonstrated subclinical joint involvement in psoriasis patients without musculoskeletal signs or symptoms. Efforts are underway to validate questionnaires that will enable dermatologists to screen patients with psoriasis for the presence of musculoskeletal disease. To date, the use of therapies in patients with early PsA has not been reported in randomized controlled trials. Moreover, conventional agents are partially effective in established PsA but, in general, trials with DMARDS have not included validated outcome measures for the different manifestations of PsA. Tumor necrosis factor antagonists can alleviate the signs and symptoms of established psoriatic arthritis and inhibit radiographic progression, but the therapeutic impact of early intervention with these agents requires further study. The extent of disease and the presence of comorbidities should be used to guide treatment decisions and to minimize adverse events.

PMID:
19806150
DOI:
10.1038/nrrheum.2009.210
[Indexed for MEDLINE]

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