Predicting and Preventing Psoriatic Arthritis

Jack Cush, MD

Oct 07, 2026 10:00 am

Psoriatic arthritis is often underdiagnosed in those with psoriasis (PsO), leading to diagnostic delays an undertreatment. While certain factors in PsO portend a future PsA risk, a predictive profile and early intervention algorithm do not exist. This cohort study suggests that PsO patients exhibit predictors that can better inform dermatologists and rheumatologists.

Data from the Stockholm Psoriasis Cohort, a prospective Swedish psoriasis inception cohort that enrolled early psoriasis (within 1 year of their first psoriasis lesion) and examined two referral models (one with biomarkers and one without) and two models for subclinical psoriatic arthritis.

Of 628 PsO participants without PsA at enrolment (55% females; median age 41 years), 83 (13%) developed psoriatic arthritis. Recursive partitioning with laboratory biomarkers stratified participants into four risk groups based on five factors (arthralgia, fatigue, psoriasis phenotype, hsCRP, and PsO disease activity) with a risks of future PsA ranging from 1% to 62%. Pain, HLA-B27, and systemic inflammation were the strongest predictors for future psoriatic arthritis.

Another recent large metanalysis of 15 studies including 124,138 psoriasis (778,690 person-years of follow-up showed biologic use was associated with a 46% lower risk of psoriatic arthritis (HR 0.54, 95% CI 0.43–0.68). Especially so for interleukin (IL)-17 inhibitors (HR 0.65) and IL-12/23 or IL-23 inhibitors (HR 0.46). IL-23 inhibitors showed greater protection than IL-17 inhibitors (HR 0.67, 95% CI 0.58–0.77).

Predicting psoriatic arthritis in new-onset psoriasis: development of multivariable prediction models from an inception cohort study

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