Implementing Psoriatic Arthritis Screening and Dietary Interventions in Dermatology Practice: A Prospective Clinical Study

Psoriatic arthritis (PsA) is a common, underdiagnosed inflammatory comorbidity of psoriasis (PsO) that can lead to irreversible joint damage without early intervention. Dermatologists are uniquely positioned to facilitate early PsA detection; however, routine screening remains inconsistent. Lifestyle interventions such as the Mediterranean diet (MD) may further enhance treatment outcomes when combined with biologic therapy.

This prospective, single-center, non-randomized controlled study evaluated routine PsA screening and treatment outcomes in an outpatient dermatology clinic. Adults with dermatologist-confirmed PsO were screened for PsA using the Psoriasis Epidemiology Screening Tool (PEST). Patients screening positive self-selected into biologic therapy alone or biologic therapy plus MD intervention. Pain severity was assessed at baseline and 1 month; logistic regression identified predictors of PsA screening positivity, and one-way ANOVA compared pain score changes among treatment groups.

a total of 117 PsO patients were screened for PsA; 72 (61.5%) screened positive, representing a statistically significant increase compared with PsA detection prior to implementation of routine PEST screening (P<0.001).Pain severity was the only significant predictor of a positive PsA screen (P<0.001). Both guselkumab- and secukinumab-treated patients were evaluated with and without adherence to the MD; guselkumab combined with the MD demonstrated the greatest reduction in pain scores at 1 month compared with biologic therapy alone (mean change 3.13 ± 1.12; P=0.01).

Implementation of routine PsA screening in dermatology practice markedly increased PsA detection. Combining biologic therapy with dietary intervention was associated with greater short-term pain reduction, supporting the utility of lifestyle changes and counseling alongside pharmacologic management in PsA care.  .