JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v3i3.2240 jpsim.v3i3.2240 Review Article Clinicopathological aspects and management of Psoriasis Hussain Asif drasifhussain@gmail.com * Consultant Physician, Clinical Director, Epping Medical Specialist Centre, Australia *Correspondence: Asif Hussain (drasifhussain@gmail.com) 12 09 2022 2022 3 3 201 209 30 03 2022 20 07 2022 Copyright © 2022 The Author(s) 2022 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Psoriasis is a common rheumatological disease worldwide. It has many articular and extra-articular complications associated with comorbidities and mortality. It's often confused with other joint diseases such as rheumatoid arthritis. Also, various patterns of Psoriasis involving skin and joints make it a clinical puzzle that can mimic many diseases and pose a great difficulty for the diagnosis. Cutaneous and rheumatological complications contribute the most to morbidity and mortality and pose great difficulty managing Psoriasis. Though the advancement in the treatment of psoriasis arthritis has improved many articular complications, it has also increased the risk of many complications such as infections and drug-related toxicities. Recently there has been development in treating psoriatic arthritis and other seronegative arthritides, which are very different from those used for rheumatoid arthritis.

It's important to understand these differences for managing patients with psoriatic arthritis, which almost every doctor sees. This review article aims to provide insight into the pathogenesis of Psoriasis, its various manifestations, and its management in light of recent evidence.

 References Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(2):14-7. Reich K, Krüger K, Mössner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque‐type psoriasis. Brit J Dermatol. 2009;160(5):1040-7. Rich P, Scher RK. Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. Am Acad Dermatol. 2003;49(2):206-12. Manhart R, Rich P. Nail psoriasis. Clin Exp Rheumatol. 2015;33(93):7–13. Jiaravuthisan MM, Sasseville D, Vender RB, Murphy F, Muhn CY. Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol. 2007;57(1):1–27. Langenbach A, Radtke MA, Krensel M, Jacobi A, Reich K, Augustin M. Nail involvement as a predictor of concomitant psoriatic arthritis in patients with Psoriasis. Br J Dermatol. 2014;171(5):1123–8. van der Velden HM, Klaassen KM, van de Kerkhof PC, Pasch MC. The impact of fingernail psoriasis on patients' health-related and disease-specific quality of life. Dermatology. 2014;229(2):76–82. Elkayam O, Ophir J, Yaron M. Psoriatic arthritis: interrelationships between the skin and joint manifestations related to the onset, course, and distribution. Clin Rheumatol 2000;19(3):301-5 Martin BA, Chalmers RJ, Telfer NR. How great is the risk of further Psoriasis following a single episode of acute guttate Psoriasis? Arch Dermatol. 1996;132(6):717-8 Sontheimer RD. Skin manifestations of systemic autoimmune connective tissue disease: diagnostics and therapeutics. Best Pract Res Clin Rheumatol. 2004;18(3):429-62. Griffiths CE, Christophers E, Barker JN, et al. classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156(2):258-62. Schäfer T. Epidemiology of psoriasis. Review and the German perspective. Dermatology 2006;212(3): 327-37. Gladman DD, Helliwell PS, Khraishi M, Duffin KC, Mease PJ. Dermatology screening tools: project update from the GRAPPA 2012 annual meeting. J Rheumatol. 2013;40(1):1425–7. Gisondi P, Tinazzi I, El-Dalati G, Gallo M, Biasi D, Barbara LM, Girolomoni G. Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study. Ann Rheum Dis. 2008;67(1):26-30. Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis. 2013;72(5):736-40. McHugh NJ, Balachrishnan C, Jones SM. Progression of peripheral joint disease in psoriatic arthritis: a 5‐yr prospective study. Rheumatol. 2003;42(6):778-83. Coates LC, Conaghan PG, Emery P, Green MJ, Ibrahim G, MacIver H, Helliwell PS. Sensitivity and specificity of the classification of psoriatic arthritis criteria in early psoriatic arthritis. Arthritis Rheum. 2012;64(10):3150-5. Queiro R, Torre JC, Belzunegui J, González C, De Dios JR, Unanue F, Figueroa M. Clinical features and predictive factors in psoriatic arthritis–related uveitis. InSeminars Arthr Rheumatism. 2002;31(4):264-270. Mallbris L, Ritchlin CT, Ståhle M. Metabolic disorders in patients with psoriasis and psoriatic arthritis. Curr Rheumatol Rep. 2006;8(5):355-63. Gladman DD. Disability and quality of life considerations. Psoriatic arthritis. Psoriatic and psoriatic arthritis: an integral approach. Heidelberg: Springer-Verlag. 2005:118-23. Palazzi C, Lubrano E, D’ANGELO SA, Olivieri I. Beyond early diagnosis: occult psoriatic arthritis. J Rheumatol. 2010;37(8):1556-8. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis & Rheumatism: Official J Am Col Rheumatol. 2006;54(8):2665-73. Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheumat Dis. 2010;69(01):48-53. Coates LC, Aslam T, Al Balushi F, Burden AD, Burden‐The E, Caperon AR, Cerio R, Chattopadhyay C, Chinoy H, Goodfield MJ, Kay L. Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study). Br J Dermatol. 2013;168(4):802-7. Mallbris L, Ritchlin CT, Ståhle M. Metabolic disorders in patients with psoriasis and psoriatic arthritis. Curr Rheumatol Rep. 2006;8(5):355-63. Kingsley GH, Kowalczyk A, Taylor H, Ibrahim F, Packham JC, McHugh NJ, Mulherin DM, Kitas GD, Chakravarty K, Tom BD, O'keeffe AG. A randomized placebo-controlled trial of methotrexate in psoriatic arthritis. Rheumatol. 2012;51(8):1368-77. Behrens F, Finkenwirth C, Pavelka K, S̆tolfa J, S̆ipek‐Dolnicar A, Thaçi D, Burkhardt H. Leflunomide in psoriatic arthritis: results from a large European prospective observational study. Arth Care Res. 2013;65(3):464-70. Sakellariou GT, Sayegh FE, Anastasilakis AD, Kapetanos GA. Leflunomide addition in patients with articular manifestations of psoriatic arthritis resistant to methotrexate. Rheumatol Int. 2013;33(11):2917-20. Mease PJ, Fleischmann R, Deodhar AA, Wollenhaupt J, Khraishi M, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, Van Der Heijde D. Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a Phase 3 double-blind randomised placebo-controlled study (RAPID-PsA). Ann Rheum Dis. 2014;73(1):48-55. Fenix‐Caballero S, Alegre‐del Rey EJ, Castaño‐Lara R, Puigventós‐Latorre F, Borrero‐Rubio JM, López‐Vallejo JF. Direct and indirect comparison of the efficacy and safety of adalimumab, etanercept, infliximab and golimumab in psoriatic arthritis. J Clin Pharm Ther. 2013;38(4):286-93. Goulabchand R, Mouterde G, Barnetche T, Lukas C, Morel J, Combe B. Effect of tumour necrosis factor blockers on radiographic progression of psoriatic arthritis: a systematic review and meta-analysis of randomised controlled trials. Ann Rheum Dis. 2014;73(2):414-9. D'Angelo S, Palazzi C, Olivieri I. Psoriatic arthritis: treatment strategies using biologic agents. Reumatismo. 2012;64(2):113-21. Adebajo, A. O. et al. Long-term 52-week results of PALACE 1, a phase 3, randomized, controlled trial of apremilast, an oral phosphodiesterase inhibitor, in patients with psoriatic arthritis. Rheumatology 53 (Suppl. 1), i141 (2014). Adebajo AO, Kavanaugh A, Mease PJ, Wollenhaupt J, Hu C, Shah K, Stevens RM, Gomez-Reino JJ. 217. Long-Term 52-Week Results of Palace 1, A Phase 3, Randomized, Controlled Trial of Apremilast, an Oral Phosphodiesterase Inhibitor, In atients with Psoriatic Arthritis. Rheumatol. 2014;53(1):i141-. Deeks ED. Apremilast: a review in Psoriasis and psoriatic arthritis. Drugs. 2015;75(12):1393–403. Coates LC, Navarro-Coy N, Brown SR, Brown S, McParland L, Collier H, Skinner E, Law J, Moverley A, Pavitt S, Hulme C. The TICOPA protocol (TIght COntrol of Psoriatic Arthritis): a randomised controlled trial to compare intensive management versus standard care in early psoriatic arthritis. BMC Musculosk Dis. 2013;14(1):1-8. Coates LC, Tillett W, Chandler D, Helliwell PS, Korendowych E, Kyle S, McInnes IB, Oliver S, Ormerod A, Smith C, Symmons D. The 2012 BSR and BHPR guideline for the treatment of psoriatic arthritis with biologics. Rheumatol. 2013;52(10):1754-7. Smolen JS, Braun J, Dougados M, Emery P, FitzGerald O, Helliwell P, Kavanaugh A, Kvien TK, Landewé R, Luger T, Mease P. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann Rheum Dis. 2014;73(1):6-16. McInnes IB, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Brodmerkel C, Li S, Wang Y, Mendelsohn AM, Doyle MK. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet. 2013;382(9894):780-9. Patel DD, Lee DM, Kolbinger F, Antoni C. Effect of IL-17A blockade with secukinumab in autoimmune diseases. Ann Rheum Dis. 2013;72(2):116-23.