As the literature on comorbidities linked to psoriatic arthritis (PsA) expands, it’s becoming more difficult for clinicians to keep up with what comorbidities should be assessed and how these comorbidities affect treatment selection. Given this, rheumatologists at the Perelman School of Medicine at University of Pennsylvania, Cleveland Clinic and Hospital for Special Surgery in New York set out to provide an update that could be applied in clinical practice. Their findings were recently published in Current Opinion in Rheumatology.
Explore this issueMay 2015
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Leading author Alexis Ogdie-Beatty, MD, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, says it is important to focus on the entire clinical picture when treating patients with PsA because the condition is not just a disease of the joints and skin. “Comorbidities need to be considered in order to provide the patient with the best care possible,” she says.
According to the review, “over half of patients with PsA have more than one comorbidity; this has a significant impact on quality of life.”1
Commenting on the review, Eric M. Ruderman, MD, professor of medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, says, “Focusing treatment on only a single aspect of the associated disease spectrum risks ignoring issues that may have significant impact on patient function and, worse, may lead to potentially avoidable long-term negative outcomes.”
This doesn’t mean that if a patient is diagnosed with PsA that he or she should be immediately screened for comorbidities, however. “Sometimes the first visit with a patient who is just being diagnosed with PsA is already overwhelming with the workup for inflammatory arthritis, the discussion about potential therapies and the screening tests needed for therapies,” Dr. Ogdie-Beatty says. “A thorough history and review of systems should be performed for all patients, and then—once the dust settles from the initial diagnosis—screening measures for comorbidities should be performed.”
Patients may not realize that there can be a relationship between PsA & eye disease.
Co-author M. Elaine Husni, MD, MPH, vice chair, Cleveland Clinic Arthritis and Musculoskeletal Treatment Center, Orthopaedic and Rheumatologic Institute, agrees. “You first want to get their disease under good control. Then subsequent visits can focus on screening for comorbidities.” Rheumatologists may prefer to administer this process, given their training in internal medicine, or they may refer the patient to different specialists for testing.