Psoriasis is a debilitating skin disease which can, in approximately 20% of cases, be complicated by joint damage (we then speak of psoriatic arthritis).
Yet common, this disease – which most often affects the folds, the scalp, the elbows, knees or the lower back and can also be found on the nails – can sometimes come up against therapeutic wandering which complicates the life of the people affected. .
An OpinionWay survey carried out last July confirms that three out of ten French people are waiting more than five years before obtaining the (correct) diagnosis of psoriasis or psoriatic arthritis, and almost half at least three years. The specialists have therefore just published recommendations for better care, revealed during a press conference organized by Janssen laboratories, which are developing immunotherapies.
Psoriasis: a diagnosis not always easy to make
If psoriasis is easily recognizable (red patches that flake) and rather well known to general practitionersoften consulted as first intention, it is less obvious when it comes to psoriatic arthritis.
A swollen finger or toe is therefore suggestive of psoriatic arthritis, as is an asymmetry of damage, for example a right wrist, a left knee and a right ankle.
“For psoriatic arthritis, the diagnosis remains more difficult, despite relatively specific pain, due to the absence of genetic markers. The presence of skin psoriasis facilitates diagnosis”, explains Bénédicte Charles, the president of France Psoriasis.
Same story from Professor Goupille, rheumatologist at the Tours CHRU: “In this disease, there are no specific antibody biomarkers. We make the diagnosis on a certain number of characteristics, in particular the locations of joint damage. A swollen finger or toe is therefore suggestive of psoriatic arthritis, as is an asymmetry of damage, for example a right wrist, a left knee and a right ankle.”.
In the presence of psoriasis plaques, the diagnosis of psoriatic arthritis will be facilitated. However, “it is not enough to have psoriasis or a history of psoriasis with pain in the joints for it to be psoriatic arthritis”, specifies the rheumatologist.
Appointment with a specialist doctor: sometimes it’s mission impossible!
“In psoriasis, the care pathway of patients is made difficult because there are not enough dermatologists. The delays in finding a specialist have lengthened and it is complicated to obtain an appointment. In this sense, it got worse”, notes Bénédicte Charles.
Which largely explains the therapeutic wandering and especially the delays in treatment. It is all the more unfortunate that today there are effective treatmentsnotably biotherapies, and that early treatment in moderate to severe forms of psoriasis can slow down the progression of rheumatism linked to the disease, or even prevent it.
Psoriatic arthritis: combined care, essential
Last point to improve according to the specialists present at the Janssen press conference: a better coordination between the different actors, in particular general practitioners, dermatologists and rheumatologists. “We need to make dermatologists even more aware of the main signs pointing towards psoriatic arthritis. Continuing to provide information to general practitioners is also essential so that, in the event of swelling of the joints and the presence of pain waking the patient at night, they have the reflex to refer them to a rheumatologist.”, continues Professor Goupille. Finally, “the impact of the disease on quality of life is often underestimated, delaying the prescription of newer medications”, regrets Bénédicte Charles.
