For US Healthcare Professionals

When PsoriaSiblings show up, refer to specialists that can help manage symptoms

Given the connection among plaque psoriasis (PsO), psoriatic arthritis (PsA), and inflammatory bowel disease (IBD), a collaborative approach between specialties can be essential for comprehensive patient care.1,2

Referral to rheumatology for symptoms of PsA

For patients with PsO presenting with symptoms of PsA, a referral to a rheumatologist is a critical step. Rheumatologists can perform a full workup, utilize formal classification criteria such as the Classification Criteria for Psoriatic Arthritis (CASPAR), and confirm a diagnosis.1,3

The window to prevent permanent joint damage is narrow: A diagnostic delay of just 6 months may directly link to an increase in permanent joint damage.3

Current diagnostic delays: The average time from musculoskeletal symptom onset to a PsA diagnosis in the US is approximately 2.5 years.4*

Referral to gastroenterology for suspected IBD

When a patient with PsO reports persistent gastrointestinal (GI) symptoms, a referral to a gastroenterologist may be warranted. This allows for a thorough evaluation to determine if IBD, such as Crohn's disease or ulcerative colitis, is present.1,3

Progressive damage in Crohn's disease: Untreated, transmural inflammation can progress to fibrotic strictures and penetrating fistulas, often requiring surgical intervention.1,5-7

Severe complication in ulcerative colitis: Uncontrolled inflammation can result in toxic megacolon and an increased risk of colon cancer.5,6

*A retrospective, population-based cohort study examined the diagnostic delay in PsA among adult patients in Olmsted County, MN, from 2000 to 2017. The study included 162 patients with a physician-confirmed diagnosis of PsA to identify factors associated with delayed diagnosis.3
If a patient with PsO is presenting any symptoms of PsA or IBD, do not wait! Early referral to a specialist can help address the risk of joint damage from PsA and serious complications from IBD.7,8

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References

  1. Chia AYT, Ang GWX, Chan ASY, Chan W, Chong TKY, Leung YY. Managing psoriatic arthritis with inflammatory bowel disease and/or uveitis. Front Med (Lausanne). 2021;8:737256. doi:10.3389/fmed.2021.737256
  2. Gracey E, Dumas E, Yerushalmi M, Qaiyum Z, Inman RD, Elewaut D. The ties that bind: skin, gut and spondyloarthritis. Curr Opin Rheumatol. 2019;31(1):62-69. doi:10.1097/BOR.0000000000000569
  3. Gottlieb A, Merola JF. Psoriatic arthritis for dermatologists. J Dermatolog Treat. 2020;31(7):662-679. doi:10.1080/09546634.2019.1605142
  4. Karmacharya P, Wright K, Achenbach SJ, et al. Diagnostic delay in psoriatic arthritis: a population-based study. J Rheumatol. 2021;48(9):1410-1416. doi:10.3899/jrheum.201199
  5. Lichtenstein GR, Shahabi A, Seabury SA, et al. Increased lifetime risk of intestinal complications and extraintestinal manifestations in Crohn's disease and ulcerative colitis. Gastroenterol Hepatol (N Y). 2022;18(1):32-43.
  6. Malik TF, Aurelio DM. Extraintestinal manifestations of inflammatory bowel disease. In: StatPearls. StatPearls Publishing; 2023. Accessed August 6, 2026. https://www.ncbi.nlm.nih.gov/books/NBK430685/
  7. Noor NM, Sousa P, Paul S, Roblin X. Early diagnosis, early stratification, and early intervention to deliver precision medicine in IBD. Inflamm Bowel Dis. 2022;28(8):1254-1264. doi:10.1093/ibd/izab228
  8. Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74(6):1045-1050. doi:10.1136/annrheumdis-2013-204858