Predicting and preventing clinical psoriatic arthritis

Psoriatic arthritis (PsA) develops in up to 30% of patients with psoriasis (PsO) and causes pain, disability and impaired quality of life despite effective therapies. Because PsO usually precedes PsA, psoriasis provides an identifiable at-risk population in whom prevention and interception strategies can be tested. This narrative review summarizes risk factors and predictors of transition from PsO to PsA, including genetic background, psoriasis severity and distribution, nail disease, obesity, mechanical stress and trauma, subclinical enthesitis, musculoskeletal symptoms and candidate biomarkers. We also discuss emerging clinical prediction tools that combine these domains to estimate individual PsA risk in psoriasis. Finally, we review evidence for interventions that may delay or reduce PsA onset, weight loss and bariatric surgery, systemic and biologic treatment of psoriasis, and early treatment of subclinical musculoskeletal inflammation, and describe ongoing imaging-enriched randomized trials such as PAMPA that will test whether PsA interception is achievable in practice.