Despite major advances in biologic and targeted synthetic therapies, the optimal timing for treatment initiation in psoriatic arthritis (PsA) remains uncertain—especially in the early, often undiagnosed, stages of disease. Growing evidence suggests that early intervention—particularly in treatment-naïve patients—may improve outcomes, yet the lack of consensus on what constitutes “early PsA” complicates both diagnosis and research. Recent studies have begun to explore the benefits of initiating b/tsDMARDs earlier, but results are mixed due to variations in trial design, patient populations, and outcome measures.

PsA may begin with subclinical symptoms—often enthesitis—before joint damage is evident. Imaging has revealed inflammation in patients with psoriasis (PsO) but no clinical arthritis, suggesting a possible window of opportunity for disease interception. However, no standardized definition exists for “pre-clinical” or “early” PsA, and diagnostic delays remain common. Observational data hint that biologic treatment for PsO may reduce the risk of developing PsA, but further prospective studies are needed. Ultimately, narrowing the time to diagnosis, identifying reliable biomarkers, and refining early treatment strategies are critical to achieving better long-term outcomes and potentially disease remission for patients with PsA.

Reference: Hen O, Harrison SR, De Marco G, et al. Early psoriatic arthritis: when is the right time to start advanced therapy? Ther Adv Musculoskelet Dis. 2024 Jul 27;16:1759720X241266727. doi: 10.1177/1759720X241266727. PMID: 39071239; PMCID: PMC11283661.