Recent research has focused on identifying and potentially preventing psoriatic arthritis (PsA) in patients with psoriasis (PsO), who are at increased risk. The European Alliance of Associations for Rheumatology (EULAR) proposed a simplified three-stage model: “at risk,” subclinical, and early PsA. Risk factors include obesity, nail disease, psoriasis severity, and family history, though genetics remain debated. Clinical signs like arthralgia and imaging abnormalities are key for identifying subclinical PsA, but diagnosis is complicated by a lack of biomarkers and heterogeneous symptoms. Tools like the CASPAR criteria help classify established disease but are less effective for early detection.

PsA is driven by both innate and adaptive immune responses, with inflammation often originating in the skin, gut, and entheses. Targeted therapies like IL-17, IL-23, and TNF inhibitors—already approved for PsO and PsA—are being studied for their potential to prevent disease progression. Retrospective studies suggest biologics, particularly IL-23 inhibitors, may lower PsA risk, though findings are mixed and subject to bias. Ongoing clinical trials will provide more definitive answers. Standardized definitions, like those from EULAR, will be essential to guide future research and preventive strategies.

Reference: Gossec L, Kerschbaumer A, Ferreira RJO, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis. 2024 May 15;83(6):706-719. doi: 10.1136/ard-2024-225531. PMID: 38499325; PMCID: PMC11103320.