Psoriatic Arthritis

Psoriatic Arthritis (PsA) is a heterogeneous condition which is associated with psoriasis.

Like rheumatoid arthritis, PsA can cause progressive joint damage and loss of function.

75-80% of patients develop psoriasis prior to the onset of their arthritis.

Most patients have a peripheral arthritis and tendon involvement or enthesitis is common.

Some patients develop spinal disease similar to Ankylosing Spondylitis.

The condition can affect all age groups including children.

The prevalence of psoriasis is 1-3%, and approximately a third of patients will develop PsA.

Risk factors for developing arthritis include: severe psoriasis, earlier onset of psoriasis, scalp, genital or nail disease, obesity, smoking, previous uveitis, family history of psoriasis, and psoriatic arthritis.

Screening and diagnosis

The PEST questionnaire is a validated tool and is recommended by NICE for annual screening for patients with psoriasis who are not known to have PsA.

Click on image below for downloadable version

 

 

Rheumatology Referral

A referral to rheumatology should be considered for patients with a PEST score of 3 or more.

A diagnosis of PsA is based on clinical evaluation, X-ray, or ultrasound findings.

Referrals can be made directly to Dr Gullick.

If a patient has clear joint swelling, they should be referred to the Early Arthritis Clinic to avoid delay.

Prereferral investigations

• FBC, U&E, CRP, Rheumatoid factor, CCP – these are often all normal.
• Plain XR – pelvis (asymptomatic asymmetrical sacroiliitis is common), hands, and feet if peripheral joint involvement is present.