In this episode of RheumaCast, we discuss the evolving concept of subclinical psoriatic arthritis and the challenges associated with its definition and clinical relevance.

The episode explores current frameworks describing the transition from psoriasis to psoriatic arthritis, highlighting the limitations of existing definitions, particularly the reliance on arthralgia and imaging findings in the absence of clinical synovitis.

A central theme is the risk of misclassification and overtreatment, given the lack of validated biomarkers, the heterogeneity of psoriatic disease, and the limited specificity of imaging abnormalities. The discussion also draws parallels with preclinical rheumatoid arthritis, emphasizing both opportunities and pitfalls of early intervention strategies.

Finally, we address key research priorities, including longitudinal psoriasis cohorts, advanced imaging approaches, and multiomic biomarker development, with the goal of improving risk stratification and enabling targeted prevention while avoiding overdiagnosis.

This episode is based on publication Kharouf F, et al. Ann Rheum Dis 2026, doi: 10.1016/j.ard.2026.03.011, and developed with NotebookLM.