PREDICTIVE FACTORS FOR THE TRANSITION FROM CUTANEOUS PSORIASIS TO PSORIATIC ARTHRITIS: AN INTEGRATIVE REVIEW

Abstract

Psoriasis is a chronic, systemic inflammatory disease that manifests predominantly in the skin but carries a significant risk of progressing to musculoskeletal involvement. The transition from cutaneous psoriasis to psoriatic arthritis marks a critical milestone in the disease's natural history, associated with impaired quality of life, reduced functional capacity, and permanent joint damage. In this context, understanding the underlying mechanisms and predictive signs preceding this progression is essential for implementing strategies for early diagnosis, timely therapeutic intervention, and personalized prevention. The objective of this study is to identify and synthesize the key clinical, imaging, metabolic, and molecular predictors associated with the progression from cutaneous psoriasis to psoriatic arthritis, based on current scientific literature. Methodology: This is an integrative literature review involving the search, selection, and critical analysis of scientific studies from indexed databases. The methodology included identifying articles published between 2010 and 2026—such as observational studies, literature reviews, and clinical research—regarding factors associated with the transition from psoriasis to psoriatic arthritis. Data synthesis considered the clinical relevance, statistical consistency, and predictive capacity of the markers identified across various epidemiological models. Results: Findings indicate that the progression from cutaneous psoriasis to psoriatic arthritis is multifactorial, involving an interplay of clinical, metabolic, immunological, and genetic factors. Key clinical predictors identified included nail involvement—particularly due to the anatomical relationship between the nail matrix and digital entheses—a positive family history, and greater severity of cutaneous manifestations. Furthermore, modifiable metabolic factors, such as obesity and elevated Body Mass Index, showed a significant association with an increased risk of progression to joint disease. Prodromal symptoms, including nonspecific arthralgia and chronic fatigue, have also been recognized as warning signs of subclinical inflammation preceding an established diagnosis. In the field of imaging, musculoskeletal ultrasound with Doppler mapping has emerged as a valuable tool for identifying early inflammatory changes in articular and entheseal structures prior to overt clinical manifestations. However, despite advances in molecular knowledge, genetic and immunological biomarkers still face limitations regarding validation and standalone application in clinical practice. Conclusion: The transition from cutaneous psoriasis to psoriatic arthritis is influenced by multiple predictive factors, most notably nail changes, severity of skin disease, obesity, prodromal symptoms, and subclinical inflammatory findings detected via imaging. Integrating these markers enhances risk stratification and supports preventive strategies in dermatology and rheumatology. Nevertheless, the validation of new molecular biomarkers and the development of more accurate predictive models remain necessary to establish a personalized, proactive approach to the disease.