EADV 2025｜皮肤病医生眼中的银屑病关节炎

在 2025 年巴黎 EADV 大会上，利兹大学皮肤科顾问医生 Laura Savage 博士与四川大学华西医院的李薇医生，围绕皮肤科医生对银屑病关节炎（PsA）的筛查与管理展开交流。二人指出，约三分之一的银屑病患者会并发 PsA，因此需重视全面筛查。李薇医生表示，接诊银屑病新患者时，会默认其有发展为 PsA 的潜在可能，通过详细询问既往病史（包括是否有过关节疼痛）、明确疼痛关节部位及特征，并结合超声、MRI 等影像学检查（约三分之二的亚临床患者存在影像异常），排查早期亚临床 PsA。Laura Savage 博士介绍，其所在中心对所有银屑病患者（无论病情轻重）采用 PEST 等问卷进行筛查，并依据 “活动后疼痛缓解、休息时加重、晨僵” 等关节疼痛特征鉴别 PsA。治疗方面，高风险患者优先选用 IL-23 抑制剂，确诊 PsA 患者可视情况选用 TNF 抑制剂（轻度银屑病）或 IL-17 抑制剂（中重度银屑病）；针对复杂病例，需与风湿科医生协作，GRAPPA 组织也在开展难治性 PsA 相关研究以提供诊疗指导。此外，二人还提及当前研究待解问题，如亚临床阶段进展为 PsA 的触发因素，以及开展大规模长期研究的必要性。

At the 2025 EADV Congress in Paris, Dr. Laura Savage (a consultant medical dermatologist from the University of Leeds) and Dr. Wei Li (from West China Hospital, Sichuan University) discussed the screening and management of psoriatic arthritis (PsA) for dermatologists. They noted that approximately one-third of psoriasis patients develop PsA, so comprehensive screening is essential. Dr. Savage’s center screens all psoriasis patients (regardless of disease severity) using questionnaires like PEST, and differentiates PsA by joint pain characteristics (relief after activity, worsening at rest, morning stiffness). Dr. Li emphasized detailed medical history-taking (including past joint pain) and using ultrasound/MRI to detect early subclinical PsA (about two-thirds of subclinical patients show abnormal imaging). They also covered treatment strategies: IL-23 inhibitors are preferred for high-risk patients, TNF inhibitors for established PsA, and IL-17 inhibitors for moderate-to-severe cases. Collaboration with rheumatologists is key, especially for complex cases, and they mentioned GRAPPA’s work on difficult-to-treat PsA. Additionally, they discussed research gaps, such as triggers for PsA progression from subclinical stages and the need for large-scale long-term studies.