Comparative PsA Risk Across Immunomodulatory Classes

Psoriatic arthritis (PsA) develops in an estimated 25% to 30% of patients with psoriasis, and unlike skin disease—where clearance is achievable and largely reversible—joint damage caused by PsA can be permanent. Francisco Kerdel, MD, FAAD, of Florida Academic Dermatology Center, frames this distinction as central to why the question of comparative PsA risk across immunomodulatory classes matters so much clinically. If certain agents are more effective at preventing the articular progression of psoriatic disease, that consideration should factor into treatment selection from the outset.

Kerdel acknowledges that early in his career, dermatologists paid little attention to psoriatic arthritis. That has changed substantially, and he now advocates for routine clinical inquiry—including questions about morning stiffness—at every patient visit, independent of how much skin disease is present. He notes that the average dermatologist does not perform comprehensive joint examinations, but recognizing early clinical symptoms and referring appropriately can prevent the irreversible sequelae of untreated joint disease.

The retrospective analysis presented at AAD 2026 assessed 3-year PsA incidence across TNF inhibitors, IL-17 agents, and IL-23 pathway agents, with the data suggesting a potential protective advantage for IL-23–targeting therapies. Kerdel describes this as an evolving story: TNF inhibitors were once considered the gold standard for PsA, followed by strong data for IL-17 agents, and now emerging evidence positions IL-23 inhibitors as comparably effective—potentially without the early radiographic limitations that initially tempered enthusiasm for this class.

He is cautious about the inherent limitations of database analyses, including selection bias and confounding, but views the signal as directionally meaningful and consistent with the broader trajectory of evidence.