Management Principles of Psoriatic Arthritis (PsA)
Patient information and decision-making Referral to a rheumatologist and multidisciplinary team Lifestyle interventions Comorbidities and extra-articular disease Patient information and decision-making The aim of treatment is to maintain a good quality of life and function. Treatment of each patient should be tailored to meet the needs of the patient according to the disease burden, taking into c
Patient information and decision-making
Referral to a rheumatologist and multidisciplinary team
Comorbidities and extra-articular disease
Patient information and decision-making
The aim of treatment is to maintain a good quality of life and function. Treatment of each patient should be tailored to meet the needs of the patient according to the disease burden, taking into consideration the predominant manifestation (axial or peripheral arthritis, enthesitis, dactylitis, skin and nail) together with extraarticular manifestations and comorbidities. A management plan should be developed based on shared decision-making between patients and clinicians, predicated on patients’ values, goals, preferences and comorbidities.
Patient education should include information about PsA disease and complications, assessment of disease, treatment goals, medications and adherence. Self-management interventions should be emphasised.
Referral to a rheumatologist and multidisciplinary team
Care of the PsA patient requires a multidisciplinary holistic approach, which might include a dermatologist, occupational therapist, podiatrist, physiotherapist, clinical psychologist or social worker, as appropriate. A rheumatology nurse can offer patient education and support, with positive effects on adherence to therapy and on HRQoL.[26]
Lifestyle interventions
Regular exercise and lifestyle modification, including smoking cessation and increased physical activity, and participation in patient support groups, should be encouraged. Disease-related problem-solving, attention to emotional well-being and communication skills are vital.
Comorbidities and extra-articular disease
The vast majority of PsA patients have one or more comorbidity, leading to premature mortality, functional impairment and reduced HRQoL.Obesity, accelerated atherosclerosis and cardiovascular events, non-alcoholic fatty liver disease, infections and osteoporosis are the major comorbidities in PsA, and need regular screening and evidence-based management.[27]
Screening for hepatitis B, hepatitis C, HIV and tuberculosis should be done at presentation. The vaccination status, pregnancy plans, contraception and lactational status of the patient should be regularly reviewed and discussed.[28]
Benitha, R., Maharaj, A. B., Makan, K., Potts, J., Lai, A., Carter, R., van Dam, M., & Hodkinson, B. (2024). South African Rheumatism and Arthritis Association 2024 guidelines for the management of peripheral spondyloarthritis. South African Medical Journal, 114(10), e2669.