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 are 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 年我们在哪里？


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，在这种情况下，皮肤疾病治疗可能会改善或预防关节炎的发展。由于皮肤和关节（尤其是附着点）之间日益公认的紧密共享的免疫病理学，这种 PsA 预防似乎是可信的。最近，几项举措探索了临床前 PsA 的概念，并且已经制定了命名法，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，即有 PsA 风险、亚临床 PsA 和早期 PsA。更好地理解早期 PsA 并识别易患其发展的个体，可以使干预措施能够“预防”PsA 的出现。最近的几项回顾性观察性研究证明了疾病拦截的可行性，即治疗银屑病患者可以预防 PsA 的出现，特别是使用生物疾病缓解药物。然而，由于一些研究的意外发现，银屑病的 TNF 抑制并没有降低 PsA 的发展速度，因此迫切需要更多数据。在这篇综述中，我们讨论了早期 PsA 的当前挑战，包括 PsA 前命名集的比较、其风险因素和疾病拦截的可能性。