Review
Intercepting the psoriasis-psoriatic arthritis continuum: a precision-medicine framework for at-risk, subclinical, and early psoriatic arthritis
F. Caso1, M. Cascone2, N. Girolimetto3, M. Megna4, F. Maione5, A. Saviano6, M. Vastarella7, M. Tasso8, R. Scarpa9, R. Giacomelli10, P. Ruscitti11
- Rheumatology Research Section, Department of Clinical Medicine and Surgery, University of Naples Federico II; and ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.
- Rheumatology Research Section, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
- UO Interaziendale Medicina Interna Ad Indirizzo Reumatologico AUSL BO-IRCCS AOU BO, Bologna, Italy.
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
- ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.
- ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy.
- Dermatology Unit, Medical Department, Antonio Cardarelli Hospital, Naples, Italy.
- Rheumatology Research Section, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy. marcotasso89@gmail.com
- Rheumatology Research Section, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Rome; and Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Italy.
CER19138
Review
PMID: 41511760 [PubMed]
Received: 25/07/2025
Accepted : 30/10/2025
In Press: 05/01/2026
Abstract
OBJECTIVES:
Psoriatic arthritis (PsA) arises in roughly 20–30% of individuals with psoriasis (PsO); notably, >80% of PsA cases are preceded by PsO after a clinically silent interval of immunogenetic priming and subclinical synovio-entheseal inflammation. Identification of this at-risk and subclinical window is hindered by absent staging criteria, validated biomarkers, and standardised surveillance, limiting opportunities for early intervention to prevent irreversible joint damage.
METHODS:
We conducted a structured narrative review of PubMed (through June 2025) targeting studies on: 1. immunogenetic and molecular drivers of PsO-to-PsA transition, 2. temporal staging frameworks and risk-stratification algorithms, 3. screening instruments and polygenic risk models, 4. imaging modalities for occult inflammation, and 5. pharmacologic and lifestyle interventions aimed at disease interception.
RESULTS:
Long-term factors (PsO severity, nail disease, family history, obesity) and short-term indicators (arthralgia, imaging-detected enthesitis or synovitis) help stratify PsA risk. Advanced ultrasound and MRI can reveal subclinical inflammation in asymptomatic PsO, though predictive validity remains to be confirmed. Observational data hint at a possible delay in PsA onset with early bDMARD exposure, but randomised prevention trials are lacking. Lifestyle interventions appear promising yet remain untested.
CONCLUSIONS:
Framing PsA as a staged continuum supports a precision-medicine model that integrates genetic profiling, validated screening, advanced imaging, and targeted intervention. Prospective, biomarker-driven trials and integrated dermatology-rheumatology pathways are needed to validate predictive algorithms and establish effective prevention and early-treatment strategies.
