Rheumatologist Dr. Gonzalez points out important pearls from his lecture Rheum/Derm Q & A at the 6th Annual Elevate-Derm Alliance Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

In conversation with Dermatology NP Veronica Richardson, Dr. Gonzalez runs through which psoriasis patients deserve a closer look for psoriatic arthritis — beyond the classic nail and scalp disease, he flags inverse (intertriginous) psoriasis and dactylitis as findings he has used to diagnose PsO himself, along with smoking, obesity, high CRP, and a first-degree relative with psoriasis. He reminds clinicians that PsA remains a clinical diagnosis with no reliable serology, so inflammatory markers, baseline X-rays, and protocol-driven in-clinic ultrasound do the work, while RF/CCP help rule out rheumatoid arthritis and HLA-B27 is reserved for axial involvement or evidence of sacroiliitis.

He then walks through why every proven dermatomyositis patient should get a myositis antibody panel, calling out MDA5 positivity as a signal for rapidly progressive interstitial lung disease and TIF1-gamma as the marker tied to malignancy — with age, skin phenotype, and the published algorithm guiding how aggressive to be with cancer screening. Looking ahead, he points to anti-interferon and JAK/TYK2 approaches for photosensitive connective tissue disease and to CAR-T "immune reset" therapy — which he is currently studying for myositis, lupus, and scleroderma — as the most exciting developments on the horizon.

  • Separate high-risk psoriasis patients using more than nails and scalp: inverse psoriasis, dactylitis, smoking, obesity, elevated CRP, and a family history of psoriasis all raise psoriatic arthritis risk.
  • PsA is a clinical diagnosis — there is no good serology; order inflammatory markers and baseline X-rays, and expect rheumatology to add protocol-specific ultrasound rather than a general hospital scan.
  • Use RF/CCP to rule out RA, and reserve HLA-B27 for patients with significant axial symptoms or sacroiliitis, since it is falsely positive in up to 7% of the white population.
  • If a patient is heading toward systemic therapy, teeing up a viral hepatitis panel and QuantiFERON-Gold/TB test before referral saves time.
  • On the myositis panel, MDA5 points to rapidly progressive ILD (get rheumatology involved), while TIF1-gamma carries up to a 50% malignancy association — let antibody, age, and skin phenotype drive how aggressively to screen.
  • CAR-T "immune reset" therapy, borrowed from heme-onc, is emerging for lupus, myositis, and scleroderma alongside anti-interferon and JAK/TYK2 strategies for photosensitive connective tissue disease.