Intercepting the psoriasis-psoriatic arthritis continuum: a precision-medicine framework for at-risk, subclinical, and early psoriatic arthritis

Objectives: Psoriatic arthritis (PsA) arises in roughly 20-30% of individuals with psoriasis (PsO); notably, >80% of PsA cases are preceded by PsO after a clinically silent interval of immunogenetic priming and subclinical synovio-entheseal inflammation. Identification of this at-risk and subclinical window is hindered by absent staging criteria, validated biomarkers, and standardised surveillance, limiting opportunities for early intervention to prevent irreversible joint damage. Methods: We conducted a structured narrative review of PubMed (through June 2025) targeting studies on: 1. immunogenetic and molecular drivers of PsO-to-PsA transition, 2. temporal staging frameworks and risk-stratification algorithms, 3. screening instruments and polygenic risk models, 4. imaging modalities for occult inflammation, and 5. pharmacologic and lifestyle interventions aimed at disease interception. Results: Long-term factors (PsO severity, nail disease, family history, obesity) and short-term indicators (arthralgia, imaging-detected enthesitis or synovitis) help stratify PsA risk. Advanced ultrasound and MRI can reveal subclinical inflammation in asymptomatic PsO, though predictive validity remains to be confirmed. Observational data hint at a possible delay in PsA onset with early bDMARD exposure, but randomised prevention trials are lacking. Lifestyle interventions appear promising yet remain untested. Conclusions: Framing PsA as a staged continuum supports a precision-medicine model that integrates genetic profiling, validated screening, advanced imaging, and targeted intervention. Prospective, biomarker-driven trials and integrated dermatology-rheumatology pathways are needed to validate predictive algorithms and establish effective prevention and early-treatment strategies.