Can We Prevent Psoriatic Arthritis?

Abstract

Psoriatic arthritis (PsA) is a chronic, inflammatory musculoskeletal disease that often develops in individuals with psoriasis (PsO), typically following an average latency period of 7 years. Without treatment, PsA can lead to irreversible joint damage, functional impairment, and a range of comorbidities. Despite therapeutic advances, only a minority of patients achieve sustained remission, highlighting the need for new approaches, including disease prevention and early interception. This review explores the emerging concept of PsA prevention in individuals with psoriasis, by addressing modifiable risk factors—such as severe skin disease, nail involvement, and obesity—and predictors such as arthralgias and asymptomatic abnormalities on musculoskeletal ultrasound. Notably, PsO patients represent a unique preventive opportunity in rheumatology, as many treatments address both PsO and PsA, potentially minimizing additional therapeutic risks.

A recently proposed framework by the European Alliance of Associations for Rheumatology (EULAR) outlines three stages of progression from PsO to PsA, ranging from individuals ‘at higher risk’, to those with ‘subclinical PsA’, and finally to those with ‘clinical PsA’. Findings from observational studies suggest that treatment of modifiable risk factors may reduce PsA incidence, though prospective data remain limited. Subclinical inflammation detected on imaging and the presence of arthralgia may identify individuals at imminent risk who could benefit from escalation of therapy. Nonetheless, further refinement of this population is necessary to avoid overtreatment. Ongoing clinical trials are expected to help clarify whether early intervention can truly intercept PsA and alter its natural history. Ultimately, success in PsA prevention will require multidisciplinary collaboration, refinement of risk stratification, and thoughtful integration of these screening strategies into clinical practice.