title: Comprehensive treatment of psoriatic arthritis: managing comorbidities and extraarticular manifestations.
abstract: Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis that can lead to decreased health-related quality of life and permanent joint damage leading to functional decline. In addition to joint and skin manifestations, both psoriasis and PsA are associated with numerous comorbidities and extraarticular/cutaneous manifestations, which may influence the physician's choice of therapy. The objectives of this review are (1) to identify comorbidities in patients with PsA based on the available evidence; (2) to examine the effects of these comorbidities or extraarticular/cutaneous manifestation on the management of patients with PsA as well as the selection of therapy; and (3) to highlight research needs around comorbidities and treatment paradigms. This review is part of a treatment recommendations update initiated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).
authors.affiliation: From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ogdie
authors.affiliation: From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic.
authors.forename: Sergio
authors.initials: S
authors.lastname: Schwartzman
authors.affiliation: From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic.
authors.forename: Lihi
authors.initials: L
authors.lastname: Eder
authors.affiliation: From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic.
authors.forename: Ajesh B
authors.initials: AB
authors.lastname: Maharaj
authors.affiliation: From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic.
authors.forename: Devy
authors.initials: D
authors.lastname: Zisman
authors.affiliation: From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic.
authors.forename: Siba P
authors.initials: SP
authors.lastname: Raychaudhuri
authors.affiliation: From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic.
authors.forename: Soumya M
authors.initials: SM
authors.lastname: Reddy
authors.affiliation: From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic. HUSNIE@ccf.org.
authors.forename: Elaine
authors.initials: E
authors.lastname: Husni
mesh_terms: D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003191:Comprehensive Health Care / Q000379:methods*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology; D016896:Treatment Outcome
keywords: AUTOIMMUNE OPHTHALMIC DISEASE; CARDIOVASCULAR DISEASE; DIABETES; METABOLIC SYNDROME; OBESITY; OSTEOPOROSIS