Moderate-to-severe psoriasis is a systemic inflammatory disease, and its comorbidities often decide the choice of treatment. At diagnosis and periodically after, ask about joint pain, morning stiffness, dactylitis and enthesitis, since psoriatic arthritis often follows skin disease and early treatment protects joints. Assess cardiovascular risk factors — blood pressure, lipids, glucose, weight and smoking. Ask about bowel symptoms, because inflammatory bowel disease affects the choice of biologic, particularly IL-17 inhibitors. And ask about mood, alcohol use and sleep. These findings steer the choice of systemic agent as much as the skin does.
- Ask about joint pain, stiffness and swollen fingers or toes at every review.
- Check blood pressure, lipids, glucose and weight, and record smoking.
- Ask about bowel symptoms before starting an IL-17 inhibitor.
- Screen for low mood and alcohol use.
Why it matters
Comorbidities often decide which systemic treatment is right, and some, such as arthritis, cause lasting damage if missed.
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