Summary
Definition
History and exam
Key diagnostic factors
- personal or family history of psoriasis
- joint pain and stiffness
- peripheral arthritis
- dactylitis
- history of scalp or nail problems
Other diagnostic factors
- enthesitis
- spinal stiffness
- reduction of cervical spine mobility
- uveitis
- inflammatory bowel disease
Risk factors
- psoriasis
- family history of psoriasis or psoriatic arthritis
- history of joint or tendon trauma
- infection
- smoking
Diagnostic tests
1st tests to order
- plain film radiographs of the hands and feet
- erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
- rheumatoid factor
- anti-cyclic citrullinated peptide (anti-CCP) antibody
- lipid profile
- fasting blood glucose
- uric acid level
- synovial fluid aspiration and analysis
Tests to consider
- plain film radiographs of the spine and pelvis
- MRI scan of sacroiliac joints
Emerging tests
- joint ultrasound
Treatment algorithm
peripheral arthritis
axial disease
enthesitis
dactylitis
Contributors
Authors
Siba P. Raychaudhuri, MD, FACP, FACR
Professor
Director, Department of Medicine/ Rheumatology, Allergy, and Clinical Immunology
University of California Davis School of Medicine
Sacramento
CA
Disclosures
SPR declares that he has received research grants, prepared research papers, and attended board meetings for Sun Pharmacy, AbbVie Pharmacy, Novartis Pharma, Johnson and Johnson, the National Psoriasis Foundation, and the US National Institutes of Health (NIH). SPR is the author of some of the references cited in this topic.
Acknowledgements
Dr Siba P. Raychaudhuri would like to gratefully acknowledge Dr Clement J. Michet, previous contributor to this topic.
Disclosures
CJM is an author of a reference cited in this topic.
Peer reviewers
Philip S. Helliwell, MD, PhD
Senior Lecturer in Rheumatology
University of Leeds
Leeds
UK
Disclosures
PSH is an author of some references cited in this topic.
Luis R. Espinoza, MD
Professor and Chief
Section of Rheumatology
Department of Internal Medicine
LSU Health Sciences Center
New Orleans
LA
Disclosures
LRE declares that he has no competing interests.
William J. Taylor, PhD, MBChB, FAFRM, FRACP
Associate Professor
Department of Medicine
University of Otago, Wellington
Wellington
New Zealand
Disclosures
WJT is an author of some references cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol. 2019 Jan;71(1):5-32.Full text Abstract
Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):700-12.Full text Abstract
Coates LC, Soriano ER, Corp N, et al; GRAPPA Treatment Recommendations domain subcommittees. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol. 2022 Aug;18(8):465-79.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Rheumatoid arthritis (RA)
- Gout
- Erosive osteoarthritis
More DifferentialsGuidelines
- 2022 American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
- EULAR points to consider for therapeutic drug monitoring of biopharmaceuticals in inflammatory rheumatic and musculoskeletal diseases
More GuidelinesPatient information
Gout
Psoriasis: what is it?
More Patient information
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