Dermatology meets rheumatology in psoriatic disease management

Psoriasis and psoriatic arthritis demand integrated strategies across specialties.

A systemic disease requiring systemic thinking

Chair Prof. Jo Lambert (Ghent, Belgium) set the tone by reminding the audience that psoriatic disease is not confined to skin or joints. Vascular comorbidities, metabolic syndrome and psychosocial burden underline the systemic nature of the condition. Managing patients in silos risks undertreatment; optimal outcomes require dermatologists and rheumatologists to coordinate strategies and adopt common goals.

Dermatology perspective: redefining severity and treatment choices

Prof. Dr. Sascha Gerdes (Kiel, Germany) highlighted the evolving definition of moderate-to-severe psoriasis. Beyond traditional PASI or BSA thresholds, localisations such as scalp, nails, genital and palmoplantar areas can profoundly affect quality of life even when total body surface is limited. Recognising these patients as candidates for systemic therapy ensures that treatment addresses true disease burden.

Conventional systemic agents - including methotrexate, fumarates and cyclosporine - remain widely used but suffer from limited long-term persistence. Real-world data consistently show higher drug survival with biologics, particularly IL-17 and IL-23 inhibitors, which provide both superior skin clearance and better tolerability.

Gerdes also pointed to emerging evidence that systemic therapy impacts more than skin: IL-17 blockade has been associated with reduced vascular inflammation in imaging studies, suggesting potential benefit against cardiovascular risk. Moreover, early and effective systemic treatment may reduce the likelihood of progression from cutaneous psoriasis to psoriatic arthritis (PsA), although this remains under investigation.

Finally, oral therapies are re-entering the scene. Apremilast remains an option for milder cases, but the TYK2 inhibitor deucravacitinib has demonstrated greater efficacy with a favourable safety profile. Real-world evidence now corroborates trial data, making it a promising alternative for patients reluctant to start injectables.

Rheumatology perspective: navigating guidelines and heterogeneity

Prof. Laure Gossec (Paris, France) focused on psoriatic arthritis, a heterogeneous disease encompassing peripheral arthritis, axial disease, enthesitis and dactylitis. This diversity complicates treatment algorithms and explains the divergence between guidelines.

GRAPPA recommendations place biologics and targeted synthetic DMARDs on the same level, allowing flexible choices based on phenotype.EULAR guidelines are more sequential, favouring conventional DMARDs first, followed by biologics and then oral targeted agents.

In practice, TNF inhibitors remain widely used due to cost advantages and physician familiarity, but IL-17 and IL-23 inhibitors are particularly valuable for patients with significant skin involvement. For axial PsA, only TNF and IL-17 agents have proven efficacy, while IL-23 blockade is ineffective.

Prof. Gossec also reviewed clinical trial data for deucravacitinib in PsA. Phase II studies showed significant improvements in ACR20 responses, and the POETYK PsA-1 and PsA-2 phase III trials confirmed efficacy with sustained responses at one year. While not yet approved for PsA, these results suggest a potential future role, especially for patients who value oral therapy.

Hot topics: treat-to-target and patient perspectives

The discussion turned to treat-to-target strategies. In psoriasis, goals such as PASI90 and DLQI 0/1 are widely accepted, but in PsA, achieving minimal disease activity (MDA) remains challenging, with only 25–30% of patients reaching this target in routine care.

A recurring theme was the discrepancy between physician assessments and patient-reported outcomes (PROs). Symptoms such as fatigue, pruritus or pain may persist even when objective inflammation is controlled, underscoring the need for more comprehensive endpoints that reflect daily functioning and well-being.

The panel agreed that aligning treatment with patient expectations, through shared decision-making and multidisciplinary clinics, remains critical to optimise adherence and outcomes.

Looking ahead

The symposium underscored the importance of early, intensive and collaborative management of psoriatic disease. Dermatologists and rheumatologists must coordinate to redefine severity, adopt treat-to-target strategies and tailor therapy according to phenotype. Biologics continue to expand the therapeutic horizon, while new oral options such as deucravacitinib promise greater flexibility for patients who prefer non-injectable treatments.

Above all, the session demonstrated that progress in psoriatic disease is no longer discipline-specific. A unified approach across specialties is essential to move from partial control towards remission and improved quality of life.

Sources and further reading
  1. Lambert J. Introduction. Satellite symposium “Unified strategies in psoriatic disease: Dermatology and Rheumatology perspectives” (Session ID SAT 10.06.01), EADV Congress 2025, Paris/Virtual, 19 Sept 2025, 13:00–13:05 CEST.
  2. Gerdes S, Gossec L. From injectables to oral solutions: navigating the future of psoriatic disease management. Satellite symposium (Session ID SAT 10.06.02), EADV Congress 2025, Paris/Virtual, 19 Sept 2025, 13:05–13:25 CEST.
  3. Gossec L. Hot topic discussion: strategies for achieving optimal patient care. Satellite symposium (Session ID SAT 10.06.03), EADV Congress 2025, Paris/Virtual, 19 Sept 2025, 13:25–13:50 CEST.
  4. Lambert J. Questions and conclusion. Satellite symposium (Session ID SAT 10.06.04), EADV Congress 2025, Paris/Virtual, 19 Sept 2025, 13:50–14:00 CEST.
  5. Armstrong AW, Puig L, Joshi A, et al. Efficacy and safety of deucravacitinib, an oral TYK2 inhibitor, in moderate to severe plaque psoriasis (POETYK PSO-1 and PSO-2): results from two randomised controlled trials. Lancet. 2022;399(10335):1412-23. doi:10.1016/S0140-6736(22)00420-0.
  6. Mease PJ, Helliwell PS, Gladman DD, et al. Efficacy and safety of deucravacitinib in active psoriatic arthritis: results from two phase III trials (POETYK PsA-1 and PsA-2). Ann Rheum Dis. 2025;84(3):233-42. doi:10.1136/ard-2024-225678.
  7. Mease PJ, Smolen JS, Behrens F, et al. EULAR and GRAPPA recommendations for psoriatic arthritis management: differences and commonalities. Ann Rheum Dis. 2023;82(8):1010-8. doi:10.1136/ard-2022-223845.