Psoriasis Awareness Month 2025
The Critical Role of Rheumatology Providers
Article contributed by Prarthana Jain, DO MPH
Established by organizations such as the National Psoriasis Foundation, Psoriasis Awareness Month occurs each August to raise public awareness of psoriasis, encourage research, improve patient care and foster community involvement. For rheumatology providers, it is an important opportunity to highlight the intersection between psoriasis and psoriatic arthritis (PsA) and to reaffirm our role in early diagnosis and multidisciplinary care.
Early Detection Matters
Diagnosing PsA remains challenging due to the heterogeneous nature of the disease. A meta-analysis of psoriasis cohorts suggests that nearly 15% of patients with psoriasis may have unrecognized PsA.¹ Diagnostic delays of one to two years are common, and such delays are associated with joint damage and worse long-term outcomes.² ³ Several factors contribute to under-recognition, including the absence of reliable serologic markers and limited musculoskeletal expertise outside rheumatology, which can make features such as enthesitis and dactylitis more difficult to identify in routine practice.
As rheumatology providers, we can significantly reduce these gaps:
- Proactive screening of all psoriasis patients for musculoskeletal symptoms.
- Coordinate with dermatology colleagues to streamline referrals.
- Educate patients with psoriasis about the risk of PsA and recognize its potential symptoms.
Clinical Insights
A structured approach to the history and physical exam, as well as focusing on the key domains of PsA, can improve detection:
- Dactylitis: Diffuse “sausage digit” swelling, which is a hallmark for PsA.
- Nail changes: Pitting, onycholysis or hyperkeratosis should heighten suspicion.
- Enthesitis: Pain at tendon insertions, especially the Achilles or plantar fascia, can precede arthritis.
- Axial disease: Inflammatory back pain, particularly with prolonged morning stiffness (>1 hour) or nocturnal pain, warrants evaluation.
- Other co-existing conditions: Manifestations such as uveitis or inflammatory bowel disease should prompt consideration of PsA.
Comorbidities
Psoriasis and PsA are systemic inflammatory diseases associated with a wide range of comorbidities. Rheumatology providers play a vital role in identifying and managing these risks:
- Cardiovascular disease and metabolic syndrome – Patients face an elevated risk and should be routinely screened.
- Obesity – Associated with higher disease activity and reduced treatment response.
- Fatty liver disease – Must be considered when selecting and monitoring therapy.
- Infections, malignancy, osteoporosis and mood disorders – Require coordinated screening and care.
Optimal management often requires collaboration with primary care, cardiology, gastroenterology, behavioral health colleagues and other specialties, while reinforcing lifestyle modification strategies with patients.
Treatment
Treatment should be tailored to the active PsA domains in each patient—peripheral arthritis, axial disease, enthesitis, dactylitis, skin and nail involvement—as well as coexisting conditions such as uveitis or IBD. Evidence-based guidelines, including those from Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), emphasize a domain-specific, patient-centered approach, with shared decision-making at the core of therapeutic planning. The GRAPPA guidelines and the American College of Rheumatology/National Psoriasis Foundation clinical practice guidelines are linked here for additional information.
How to Get Involved This Month
Psoriasis Awareness Month offers opportunities for NCRA members to engage beyond the clinic:
- Share educational resources from the National Psoriasis Foundation with patients and colleagues.
- Partner with local dermatologists for joint patient education initiatives.
- Encourage patients to participate in support networks or research registries to advance understanding of PsA.
Engage in advocacy efforts by supporting state or national initiatives that promote access to dermatology and rheumatology care.As rheumatology providers, we are uniquely positioned to improve outcomes for patients living with psoriasis and PsA through early recognition, domain-focused treatment and careful management of comorbidities. This Psoriasis Awareness Month, let’s strengthen collaboration across specialties, amplify patient advocacy and apply evidence-based strategies to improve care throughout North Carolina.
References:
- Villani AP, Rouzaud M, Sevrain M, et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: Systematic review and meta-analysis. J Am Acad Dermatol. 2015;73(2):242-248. doi:10.1016/j.jaad.2015.05.001
- Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74(6):1045-1050. doi:10.1136/annrheumdis-2013-204858
- Tillett W, Jadon D, Shaddick G, et al. Smoking and delay to diagnosis are associated with poorer functional outcomes in psoriatic arthritis. Ann Rheum Dis. 2013;72(8):1358-1361. doi:10.1136/annrheumdis-2012-202608