Psoriatic arthritis: the role of the nonphysician clinician in the diagnosis and treatment of patients with psoriasis

Psoriatic arthritis is a clinically heterogeneous, chronic, and progressive disease that develops in up to 30% of patients with psoriasis and is characterized by multiple and increasing joint defects caused by persistent immune-mediated inflammation. Several treatment options are available, including multiple biologic agents that inhibit specific cellular mediators of inflammation either directly or indirectly. Early detection and intervention are critical to preventing severe joint damage and pain, necessitating increased awareness and education about this disease for primary providers and nonphysician clinicians. Physician assistants and nurse practitioners, given their role in the primary care setting and within multiple specialty areas such as dermatology and rheumatology, are often the first to see patients who may have psoriatic arthritis. These healthcare providers are increasingly important in the early diagnosis and treatment of this disease. In this review, we provide an overview of psoriasis and psoriatic arthritis and discuss the multiple treatment options that are available for these patients. We also discuss ways to help recognize early joint involvement in the clinic and emphasize the role that nonphysician clinicians play in the care of patients with psoriatic arthritis.