Editorial Comment as preface to report link below.
Psoriasis is a common disease and presents to primary care frequently. Its management can be problematic and patients find the treatments unpleasant. Psoriatic arthritis is a poorly-understood co-morbidity. In my experience physicians from general practitioners to orthopaedic surgeons do not recognise the presenting features of psoriatic arthritis, and I often see patients who are referred to my musculoskeletal clinic with joint pain and swelling who have psoriasis, but the link between the two conditions has not been made.
Within specialist rheumatology there has traditionally been a reluctance to treat psoriatic arthritis aggressively. Only recently has it been understood that the pathological processes in psoriatic arthritis can be just as destructive as in rheumatoid arthritis and that patients are subject to an increase in cardiovascular morbidity. I think we need to become more vigilant as primary care practitioners and refer patients who have psoriasis and are presenting with joint pain and swelling straight on to specialist care.
Philip Helliwell is a recognised authority on psoriatic arthritis and spondyloarthropathies and trained as a GP before becoming a rheumatologist. He shows a clarity of thought and expression which is the result of his dual training. He describes eloquently those features of the disease which are likely to be presenting symptoms and signs in primary care and instructs us how to diagnose and manage these patients.
Louise Warburton
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