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As a Black doctor specializing in psoriatic arthritis (PsA), I have noticed the difficulties in diagnosing and managing this condition. This is especially true for Black patients. While PsA is often less diagnosed in general, the unique presentations in Black patients further complicate its identification and treatment. In this article, I’ll share insights about PsA in Black patients, the barriers they face, and how we can work together to improve care.
Understanding Psoriatic Arthritis
Psoriatic arthritis is diagnosed less in Black patients than in White patients. This may be due to mistakes in diagnosis, not real differences in how many actually have it. Diagnosing PsA in Black patients requires an increased awareness of how the condition can look differently from the textbook descriptions. One of the primary challenges lies in how psoriasis appears in the skin, which often differs in darker skin tones. In Black patients, psoriasis may show up as purple or dark patches. This is different from the usual “salmon-colored plaques” seen in lighter skin. Doctors need to think about the different skin conditions that can look like psoriasis. They should take a detailed history and do a physical exam. This helps them find subtle signs, like nail pitting or swelling in fingers or toes.
Psoriasis can easily be mistaken for other conditions such as eczema or fungal infections. Additionally, psoriasis may manifest in less typical areas, such as the scalp, palms, or soles, further complicating diagnosis.
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Many Black patients suffer silently without a proper diagnosis or treatment plan. Healthcare providers must recognize these unique presentations and advocate for improved access to care.
Managing Co-Existing Conditions
PsA is more than just a joint or skin condition; it’s a disease that affects your overall health. Black patients often have higher rates of co-existing conditions such as diabetes, hypertension, and heart disease. These conditions complicate PsA management and influence treatment decisions.
Some anti-inflammatory drugs for PsA can raise the risk of heart failure. This makes them less ideal for patients who already have heart problems. Similarly, medications like acitretin, processed in the liver, require caution in diabetic patients due to potential impacts on cholesterol and liver function.
Treatment Approaches
Topical Treatments: On-skin treatments remain foundational in managing psoriasis, especially for localized skin involvement. For Black patients, I often recommend ointments over creams, as they provide better hydration and penetration into plaques.
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Strong steroids like clobetasol and betamethasone work very well. Using them with vitamin D analogs like calcipotriol can improve results. This combination can also lower the side effects of steroids.
Phototherapy: Narrowband UVB phototherapy is an excellent option for patients with widespread skin involvement. It works well in reducing inflammation and improving the appearance of plaques, even on darker skin tones. Phototherapy only treats skin symptoms. It should be part of a larger treatment plan for patients with serious joint disease.
Systemic Therapies: For more severe PsA, systemic therapies are important. These include biologics and oral medications like apremilast. These treatments target both skin and joint inflammation. In Black patients, careful consideration of co-existing conditions guides the choice of treatment to ensure safety and that it works well.
Addressing Disparities in Clinical Research Studies
Black patients are not well represented in clinical studies for PsA, which limits our understanding of how treatments work for them. Barriers to participation include limited access to research sites, mistrust of the medical system, and logistical challenges such as time off work or transportation. To improve representation, we must bring studies to underserved communities, provide compensation and flexible scheduling, and rebuild trust through transparency and community engagement.
Empowering Patients Through Education and Advocacy
Education is a powerful tool for improving outcomes. Black patients should know that PsA is a condition they can manage. Patients should look for early signs like unexplained joint swelling, nail pitting, or heel pain that is worse in the morning. Talking about these symptoms with a healthcare provider can help get a proper check-up. This can lead to an earlier diagnosis and treatment.
As a doctor, my goal is to provide compassionate, comprehensive care for all patients with PsA. By paying attention to the needs of Black patients, we can improve their care. These steps can lead to better diagnosis, treatment, and quality of life. PsA doesn’t have to define a patient’s life—with the right care and support, they can thrive.
Dr. Zoë Indigo Smith is a board-certified dermatologist. Dr. Zoë completed her dermatology residency at UCLA where she trained in medical and cosmetic dermatological surgery.
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