Skin and Nail Predictors of Psoriatic Arthritis Development: A Holistic Overview Integrating Epidemiological and Physiopathological Data

Dermatological manifestations are considered to be of significant importance in identifying individuals with psoriasis at a higher risk of developing arthritis, as rheumatological involvement typically follows the onset of skin/nail lesions. This review summarizes the literature evidence about dermatological predictors of psoriatic arthritis (PsA) development, also analyzing the underlying physiopathological mechanisms and potential biases. Such an integration between statistical evidence and a mechanism-based approach aims to emphasize the most robust skin/nail risk factors upon which clinicians should focus most in daily clinical practice. Accordingly, psoriasis severity and nail changes due to matrix involvement would result in the most relevant risk factors for PsA occurrence, while other possible predictors (e.g., scalp and inverse psoriasis) do not seem to be supported by a significant pathogenetic link.