State of art and future challenges to early intervention, and management in patients with psoriasis at increased risk of transition to psoriatic arthritis: a review

Introduction: Up to 30% of patients with psoriasis develop psoriatic arthritis (PsA) during their lifetime, which can result in irreversible joint damage. Early identification and interception of PsA could potentially decrease inflammation and progression of structural damage. This review summarizes the state of the art on psoriasis-to-PsA transition and discusses the challenges to prevent and early manage PsA. Areas covered: One primary hurdle clinicians face is their inability to establish an early PsA diagnosis because of the poor specificity of symptoms. Arthralgia, severe psoriasis, a history of uveitis, nail psoriasis, scalp psoriasis, having a first-degree relative with PsA, familial aggregation, genetic factors, specific skin phenotypes, mechanical stress, and obesity confer an increased risk of PsA transition. However, underlying molecular and cellular mechanisms remain poorly defined. Expert opinion: The evolution from cutaneous to synovio-entheseal inflammation in patients with psoriasis presents an opportunity to investigate the critical events linked to arthritis development. Further efforts should be made to clearly define early PsA and identify patients with psoriasis at increased PsA risk. Machine learning and artificial intelligence may analyze and integrate different factors to more objectively estimate the possible risk of psoriasis to PsA transition for each patient. Plain language summary: About 30% of patients with psoriasis will eventually get psoriatic arthritis, an inflammatory disease that can cause irreversible joint damage. Early identification of psoriatic arthritis in these people may prevent joint and bone damage from developing.The state-of-the-art method in identifying psoriasis patients at high risk of developing psoriatic arthritis is the focus of this review.The characteristics of patients, including risk factors, that are relevant to developing psoriatic arthritis will be detailed. The most prevalent imaging techniques will be reviewed to determine their potential in the early diagnosis of psoriatic arthritis in patients with psoriasis. Finally, some insights on using artificial intelligence tools to prevent the shift from psoriasis to psoriatic arthritis are also provided.