Understanding the spectrum from preclinical psoriatic arthritis to early diagnosis of the disease

Psoriasis is a chronic inflammatory skin disease that often precedes the development of psoriatic arthritis. Advances over the past 10 years have deepened our understanding of the transition from skin inflammation to joint inflammation, revealing various phases during which genetic, environmental, and immunological factors can affect this transition. In 2023, a European Alliance of Associations for Rheumatology task force outlined key considerations for identifying individuals with subclinical disease from those with clinically stabilised disease. Discerning between subclinical psoriatic arthritis and very early disease is crucial and raises doubts and questions about when an individual transitions from being at risk to having established psoriatic arthritis. Labelling this stage as very early psoriatic arthritis rather than subclinical disease might have substantial clinical and therapeutic implications. This Viewpoint highlights the importance of precisely identifying the different stages of progression of psoriatic arthritis for timely interventions and better outcomes for patients.