The first guidelines aimed at educating doctors about the need to screen patients with psoriatic arthritis for conditions that often accompany the disease have been drafted in an effort to increase awareness that the chronic, inflammatory arthritis affects more than just skin and joints.

“I think the comorbidities for psoriatic arthritis have been underappreciated and underreported, and I think this [draft] starts to provide some evidence base that we do need to be more aware,” explains Elaine Husni, MD, director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic. Dr. Husni headed the group that drafted the new guidelines at a joint meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and the Spondyloarthritis Research and Treatment Network (SPARTAN) in New York City this summer.

What really is important is to treat the patient as a whole and to say there are associated conditions that are more common with people with psoriatic arthritis, and physicians treating these patients should be made aware,”she explains.

Psoriatic arthritis is an autoimmune type of arthritis that affects as many as 30 percent of patients with the chronic skin condition psoriasis. Generally, the arthritis appears several years after the onset of psoriasis, although in some cases it can appear before or at the same time that the skin condition begins. In addition to psoriasis’ red, scaly rash, symptoms of psoriatic arthritis include painful and swollen joints, morning stiffness, reduced range of motion and general fatigue.

Dr. Husni says recent research is now starting to reveal new information about broader health risks for this group of patients. Topping that list: cardiovascular disease. So the first recommendation is that all psoriatic arthritis patients be screened for it.

“We now know that cardiovascular disease is more prevalent [than in the general population],” says Dr. Husni. Although a sedentary lifestyle, obesity or treatment with corticosteroids may contribute to the risk, she says there are clearly disease-specific factors that can lead to heart disease. “So that tells us it’s the disease itself,” she says.

The group that drafted the guidelines also found strong evidence that shows an association between psoriatic arthritis and inflammatory bowel disease, as well as ophthalmic conditions, such as uveitis, so the group is recommending screening for those conditions, too.

Psoriatic arthritis is classified as a spondyloarthropathy, a group of diseases with common features and overlap. They usually involve the spine and the pelvis (sacroiliac joint), and affect the entheses (the locations where ligaments and tendons attach to bone). They may also be associated with a particular gene called HLA-B27. Other spondyloarthropathies include ankylosing spondylitis, enteropathic arthritis (arthritis that is linked to inflammatory bowel diseases) and reactive arthritis.