Kristina Callis Duffin, MD highlights important clinical insights from her lecture Psoriasis Updates on Saturday, November 5, 2022 at the PA/NP Elevate-Derm Conference in Tucson, Arizona.
In this video
With so many options now on the market — four TNFs, the IL-12/23, three IL-17s, three IL-23s, plus orals like Otezla and the newer JAKs — Dr. Callis Duffin describes how she helps patients who have moved beyond topicals. She starts by reviewing what they've been on and failed, whether they have a history of arthritis, and what comorbidities and medications they carry, then walks them through what she calls "the grid": a one-page handout (available on the website) that lays out every option in one place. It's a modified shared decision-making approach — finding common ground while steering patients toward the class that's actually best for them, since comorbidities like heart disease, liver disease, MS, or inflammatory bowel disease determine the right agent.
She stresses digging past the generic "do you have joint pain?" question, since inflammatory arthritis can present as stiffness, back pain, a swollen digit, or heel and foot pain from enthesitis and plantar fasciitis. Asking about more than an hour of morning stiffness helps distinguish inflammatory from osteoarthritis — and catching true psoriatic arthritis early matters, because even six months of delay can lead to disability. On nails, she notes adalimumab carries nail-disease data in its label, but all the biologics have nail efficacy data and work better than the current oral agents, so the best move is simply to pick the right biologic class for the patient's psoriasis.
- Before selecting a systemic, review prior therapies and failures, arthritis history, and comorbidities like heart disease, liver disease, MS, and inflammatory bowel disease — they narrow the options.
- Use "the grid" — a one-page handout of all the options — to make treatment selection a shared, comfortable decision, since most patients don't realize how many choices exist.
- Screen for psoriatic arthritis beyond the generic joint-pain question: ask about back pain, morning stiffness over an hour, swollen digits, and heel or foot pain.
- Catch psoriatic arthritis early — even six months of delay can lead to disability.
- For nail psoriasis, topicals won't work; all biologics outperform current orals, so choose the right biologic class for the patient's skin disease and nails will likely improve.
