Dr. Gonzalez, a rheumatologist, discusses how he manages psoriasis comorbidities from his lecture Managing Psoriasis & Comorbidities with a Rheumatologist at the 6th Annual Elevate-Derm Alliance Conference at theJW Marriott Water Street in Tampa, Florida.

In this video

In conversation with Veronica Richardson, Dr. Gonzalez addresses why early recognition matters — most patients present with skin findings first, roughly 30% go on to develop psoriatic arthritis, and even a six-month delay in diagnosis can lead to permanent joint destruction. He walks through a practical "top-to-bottom" joint exam derm clinicians can do in a couple of minutes: checking the sternoclavicular joints and elbows for enthesitis, the wrists, and the MCPs, PIPs, and DIPs, then comparing hands side by side to catch the asymmetry and "sausage digit" dactylitis that he calls almost pathognomonic. He stresses taking the shoes and socks off to look for dactylitis and enthesitis at the plantar fascia and Achilles insertion. For axial disease, he asks whether back pain wakes patients in the middle of the night, whether it improves with activity, and how long morning stiffness lasts.

Dr. Gonzalez explains how disease pattern and comorbidities steer therapy — he thinks in terms of the recognized domains (enthesitis, dactylitis, axial, synovitis, nail, skin) plus uveitis, IBD, depression, and infection risk. He notes IL-23 blockers didn't work for ankylosing spondylitis, so he does not use them first-line for confirmed axial disease (though a trial he's involved in may change that), and he points to emerging gender-based differences in treatment response. Above all, he emphasizes shared decision-making: if you don't have a rheumatologist "on speed dial," find one. Looking ahead, he's excited about safer agents, better musculoskeletal efficacy, diagnostics to guide treatment, and more data on combination therapy for recalcitrant patients.

  • Get patients to rheumatology early — even a six-month delay in diagnosing psoriatic arthritis can cause permanent joint destruction.
  • Do a fast top-to-bottom joint exam: SC joints, elbows and knees for enthesitis, wrists, and MCPs/PIPs/DIPs; compare hands side by side for asymmetry and dactylitis, and always take shoes and socks off to check the feet.
  • Screen for inflammatory back pain by asking if the pain wakes the patient at night, improves with activity, and causes prolonged morning stiffness.
  • Let domains and comorbidities drive drug choice — avoid IL-23 blockers first-line in confirmed axial psoriatic disease, and account for uveitis, IBD, depression, and infection risk.
  • Prioritize dermatology–rheumatology collaboration; resist switching therapies quickly without considering the full psoriatic arthritis picture.