Psoriatic Arthritis Burden
Psoriatic arthritis (PsA) is a progressive inflammatory condition that predominantly affects the skin, joints, nails, and entheses. Around 1 in 5 patients with psoriasis (PsO) have PsA and for the vast majority of patients, the development of PsA arises either concurrently or following the onset of PsO.
The economic burden of PsA is substantial, where costs for PsA are three times higher in the US than for patients with PsO alone. This highlights a clear unmet clinical need for the treatment and management of these patients. PsA patients also attribute to a significantly greater proportion of healthcare utilization: PsA patients have 42% more visits to the healthcare provider (HCP) in the first year than PsO patients, indicating challenges in reaching a diagnosis and implementing early treatment for PsA.
Optimized diagnosis and treatment of PsA is critical for the preservation of a patient’s mobility, mental health and quality of life, and can be achieved with close monitoring of a patient’s progress following diagnosis of PsO.
Development of Psoriatic Arthritis
Certain risk factors have been associated with the development of PsA in individuals with PsO and these include:
- High cholesterol
- Psoriasis severity, number of sites affected, and location (e.g. nails)
- Musculoskeletal symptoms including pain, fatigue and stiffness, or trauma
- Gut inflammation
- Genetic links (familial history, or presence of the HLA-B27 allele)
Patients with PsA also frequently experience one or more comorbidities and these can include:
- Metabolic syndrome (the combination of hypertension, hyperlipidemia, and Type 2 diabetes)
- Inflammatory bowel disease
- Fatty liver disease
- Mental health conditions such as depression and anxiety
- Cardiovascular disease
It has also been shown that obesity, hypertension and a Charlson Comorbidity Index of ≥1 were prognostic factors for poorer treatment outcome rates in PsA.
The Current Psoriatic Arthritis Journey
Delays in Diagnosis
Patients often experience slow diagnosis of PsA, sometimes delayed for more than 2 years after symptom onset. While patients already experience clinical inertia in the management of their PsO, not reaching a diagnosis for PsA, in addition, can mean patients are faced with a heavy burden of multiple diseases with limited support and only modest satisfaction with the treatment.
Excessive Trial and Error
Patients who become frustrated with the lack of results seen from their current prescription may wane in their treatment adherence. Without the HCP setting realistic expectations in skin clearance timeframes, patients can experience a succession of treatment trials in the hopes that one may be successful. Some may be left using topical treatment alone for cutaneous symptoms, with no treatment for their arthritic symptoms.
PsO patients treated with biologic agents exhibited highest treatment satisfaction over oral therapy, phototherapy, and topical therapy. However, one study shows an apparent lack of confidence in HCPs to prescribe these newer therapeutics, despite up to 15 years of efficacy and safety data in place for some biologics.
A recent roundtable discussion amongst dermatologists cited one of the predominant reasons for reluctance to initiate biologic therapy was the inconvenience of providing patient education on the safety of these agents. This leaves patients in a cycle of undertreatment and progressively worsening disease.