Regardless of who performs the testing, communicating with the patient and the patient’s primary care physician about medical comorbidities associated with PsA is critical.
“Patients should be aware of the association with cardiovascular disease in particular so that they are empowered to participate in their own care and advocate for routine screening with their primary care physician,” Dr. Ogdie-Beatty says. “It is equally important for a rheumatologist to communicate with the patient’s primary care physician because most are unable to keep up with the literature in the many areas of medicine. Thus, we need to inform them of what they should be watching for, partner with them in performing screening tests and stay on the same page with regard to PsA management.”
Notable Comorbidities
Among the 13 comorbidities highlighted in the review, cardiovascular disease and diabetes may have the greatest impact on a patient’s life, Dr. Ogdie-Beatty says, so it’s worth paying the closest attention to these conditions. Additionally, there are existing screening guidelines for the general population for these diseases that either the rheumatologist or the primary care physician can facilitate.
Dr. Husni also would advise patients to see an ophthalmologist if they experience symptoms, such as eye dryness, redness, pain or vision loss. “Patients may not realize that there can be a relationship between PsA and eye disease,” she says.
In addition, Dr. Ruderman says it’s important to focus on the comorbidities that are both very common and potentially treatable, notably hyperlipidemia and atherosclerosis, diabetes, obesity and depression. “Recognizing those diseases, such as uveitis and inflammatory bowel disease, that are as much associated conditions as comorbidities, is also very important,” he continues.
Elinor A. Mody, MD, director, Women’s Orthopedic and Joint Disease Program, Brigham and Women’s Hospital, Boston, who also commented on the review, singled out depression as a comorbidity to watch for. “This is a condition that we aren’t as good at screening for,” she says. “So be sure to alert the patient’s primary care physician if you don’t screen for it yourself.” Psoriasis is associated with increased risk of suicide and alcoholism.
Rethinking Treatments
Being aware of comorbidities is crucial when prescribing medications. In particular, nonsteroidal antiinflammatory drugs (NSAIDs) should be prescribed with caution in patients with PsA and certain other conditions. NSAIDs can cause elevated liver transaminases (particularly in the setting of existing liver disease); may cause flares in Crohn’s disease and ulcerative colitis; may increase the risk of cardiovascular events, such as stroke or myocardial infarction, in patients with existing cardiovascular disease; may cause fluid retention or decompensation in congestive heart failure; and may be problematic in patients with chronic kidney disease because they are linked to increased risk for acute kidney injury or worsening kidney disease.
