Yasser EI Miedany
There is a growing interest in psoriasis and psoriatic arthritis which moved from rather restricted and longstanding disease approach to a more comprehensive view, encompassing not only inflammatory back pain, but also peripheral arthritis, enthesitis, as well as co morbidities and extra-articular manifestations. The fact that psoriasis precedes joint disease in most patients provides an opportunity to identify those patients most likely to develop arthritis. The introduction of the “window of opportunity” concept into psoriatic arthritis management and the potential role of “early psoriatic arthritis” service to identify those suffering from active inflammatory disease have led to a significant change in the way these patients are managed. The recognition of a non-radiographic stage in early spondyloarthritis
opened the door for imaging modalities such as MRI and US to book its place in the diagnosis of the pre-radiographic changes. This article will focus on recent developments in PsA pathogenesis, diagnostic strategies to identify patients with early psoriatic musculoskeletal inflammation in standard clinical practice and the implementation of patient reported outcome measures as well as imaging modalities for the diagnosis and management of the disease.