Psoriatic arthritis (PsA) is a chronic rheumatic disease that usually appears in patients with skin psoriasis, making it a model for detection of joint disease in the pre-clinical phases in a setting where therapy for cutaneous disease may ameliorate or prevent arthritis development. Such PsA prevention appears credible due to the increasingly recognized closely shared immunopathology between the skin and joints, especially the entheses. Recently, several initiatives have explored the concept of pre-clinical PsA, and nomenclatures have been developed with the recent EULAR nomenclature proposing a simplified three stages from psoriasis to clinical PsA development, namely at risk of PsA, subclinical PsA and early PsA. A better comprehension of early PsA and the identification of individuals predisposed to its development could enable interventions to ‘prevent’ the appearance of PsA. Several recent retrospective observational studies have demonstrated disease interception feasibility, i.e. treatment of people with psoriasis may prevent the appearance of PsA, in particular using biologic disease-modifying drugs. However, further data is urgently required due to unexpected findings in some studies where TNF inhibition for psoriasis does not reduce the rate of PsA development. In this review we address the current challenges in early PsA, including comparisons of pre-PsA nomenclature sets, its risk factors, and the potential for disease interception.

中文翻译：

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亚临床银屑病关节炎和疾病拦截——2024 年我们将走向何方？


银屑病关节炎 (PsA) 是一种慢性风湿性疾病，通常出现在皮肤银屑病患者中，使其成为临床前阶段检测关节疾病的模型，在皮肤疾病治疗可以改善或预防关节炎发展的情况下。由于越来越多的人认识到皮肤和关节（尤其是附着点）之间密切​​共有的免疫病理学，这种 PsA 预防似乎是可信的。最近，多项举措探索了临床前 PsA 的概念，并制定了命名法，最近的 EULAR 命名法提出了从银屑病到临床 PsA 发展的简化三个阶段，即处于 PsA 风险、亚临床 PsA 和早期 PsA。更好地理解早期银屑病关节炎和识别易患银屑病关节炎的个体，可以采取干预措施“预防”银屑病关节炎的出现。最近的几项回顾性观察研究已经证明了疾病拦截的可行性，即治疗银屑病患者可以预防银屑病关节炎的出现，特别是使用生物疾病缓解药物。然而，由于一些研究中的意外发现，TNF 抑制银屑病并不能降低 PsA 的发生率，因此迫切需要进一步的数据。在这篇综述中，我们讨论了早期 PsA 面临的当前挑战，包括 PsA 之前命名集的比较、其风险因素以及疾病拦截的潜力。