Explore psoriatic arthritis through the expert eyes of Philip Helliwell, Professor of Clinical Rheumatology at the University of Leeds, and Honorary Consultant Rheumatologist for the Bradford Hospitals NHS Trust, who talks to NIHR about the condition’s life-impacting potential for patients and why treatment must not be delayed.

What fraction of the population are most likely to develop psoriatic arthritis?

Three per cent of the population have psoriasis, and a third of those have psoriatic arthritis – males and females equally, and young and old. In the population at large, it’s about one per cent probably.

Are there any patterns in the nature and frequency of the condition’s flare-ups?

A lot of people say that stress is a trigger, and so is any form of trauma – whether it’s psychological or physical. Each individual varies and differs in terms of their flare-ups so we can’t give an accurate figure but flare-ups are certainly a characteristic of the disease.

How does psoriatic arthritis affect the individual’s mental health?

Psoriatic arthritis impacts the patient’s physical and mental health in many ways. In fact, one of the comorbidities of this condition is depression and self-harm, but I don’t think there’s enough awareness of these effects.

What should the psoriatic arthritis care pathway look like?

Basically, there has to be an awareness of the association between arthritis and psoriasis – that’s the first hurdle to overcome, for both the physician and the patient. Very few people know of the link.

There is a frequent delay in diagnosis and referrals for psoriatic arthritis and patients should be seeing their GP a lot earlier. But a lot of patients are put off seeing their GP because they’ve had treatment in the past which hasn’t worked – they’re not turning to them when they should be to get an on-ward referral.

The condition should be treated with a multidisciplinary approach across specialties. Skin, joints, mental health, cardiac, gastroenterology, for example, should all be involved in the patient’s health.

What treatment strategies should be considered by the healthcare professional?

The treatment for psoriatic arthritis is complex and guidelines and recommendations have been produced as a result. The treatment should be tailored to the sort of disease which the patient presents with. There is not a single pathway, but numerous, depending on how the patient is.

As far as the individual’s self-help goes, we advise healthy living, weight-loss, alcohol abstinence, no smoking, and exercise. It’s the generic advice that patients attending to their GP receive, but those factors have specific relevance to this condition.

What danger lies in delayed treatment – or the absence of it?

The psoriatic arthritis patient will experience more damage if treatment is delayed. In fact, a study from Dublin showed that a six-month delay in treatment causes severe damage, so that six-month cut-off is crucial.

It’s 95 per cent true that patients who adhere to the treatments can live a happy and healthy life – nowadays, the majority of the patients are successful with treatment – but there’s a small group that we struggle with.

How has the sector’s approach to psoriatic arthritis – as well as the avenues of treatment – evolved over the years?

There’s no doubt that we’re not seeing the problems which we saw in the past. That’s true of all arthritis, not just psoriatic arthritis. Rheumatology, as well, has developed and we have better treatment and awareness now. However, even though there has been improvement, there’s still room for a lot more to come, particularly in getting patients in to see a specialist earlier. From my point of view, if we could improve that referral time by just a few months for our patients, it would make a huge difference. We’re actually currently conducting a national study which will be published in the next year or two to prove that earlier referral improves outcome.