Psoriatic arthritis diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
The diagnosis of psoriatic arthritis is easily confirmed when the cutaneous manifestations of psoriasis coexist with arthritis. There is no definitive diagnostic test for psoriatic arthritis. It must be differentiated from other arthritides based on the joint involvement patterns, clinical features, imaging and laboratory studies. The CASPAR criteria (ClASsification criteria for Psoriatic ARthritis) has been propsed to diagnose psoriatic arthritis using point scoring system.
Diagnostic Study of Choice
- There is no definitive diagnostic test for psoriatic arthritis.
- Radiography, MRI and CT scan may be helpful in diagnosing psoriatic arthritis from other arthritides.
Diagnostic Criteria
- The diagnosis of psoriatic arthritis is easily confirmed when the cutaneous manifestations of psoriasis coexist with arthritis.[1][2][3][4]
- It must be differentiated from other arthritides based on the joint involvement patterns, clinical features, imaging and laboratory studies.
- The following manifestations may be helpful in diagnosing psoriatic arthritis in an individual in the absence of psoriatic skin lesions.[5]
| Family history of psoriasis in first degree relatives |
| Asymmetric joint distribution |
| Involvement of distal joints |
| Nail involvement (eg, pitting, nail bed destruction, onycholysis) |
| Dactylitis |
| Hidden psoriatic plaques |
- The CASPAR criteria (ClASsification criteria for Psoriatic ARthritis):[6]
- The CASPAR study stated that a patient present with inflammatory articular disease (inflammatory peripheral arthritis, enthesitis, spondylitis) can be diagnosed as having psoriatic arthritis if a total of at least three points are present from the presence of the following possibilities.
| Manifestation | Point score |
|---|---|
| Skin lesions | Current psoriasis: 2 points
Previous history of psoriasis: 1 point The family history of psoriasis: 1 point |
| Dactylitis | 1 point |
| Nail dystrophy | 1 point |
| Juxtra articular new bone formation | 1 point |
| Abscence of rheumatoid factor | 1 point |
- The specificity is approximately 98.7% and sensitivity is approximately 91.4%.
References
- ↑ Liu JT, Yeh HM, Liu SY, Chen KT (September 2014). "Psoriatic arthritis: Epidemiology, diagnosis, and treatment". World J Orthop. 5 (4): 537–43. doi:10.5312/wjo.v5.i4.537. PMC 4133459. PMID 25232529.
- ↑ WRIGHT V (December 1956). "Psoriasis and arthritis". Ann. Rheum. Dis. 15 (4): 348–56. PMC 1006908. PMID 13395269.
- ↑ Helliwell PS, Taylor WJ (March 2005). "Classification and diagnostic criteria for psoriatic arthritis". Ann. Rheum. Dis. 64 Suppl 2: ii3–8. doi:10.1136/ard.2004.032318. PMC 1766878. PMID 15708931.
- ↑ Punzi L, Pianon M, Rossini P, Schiavon F, Gambari PF (April 1999). "Clinical and laboratory manifestations of elderly onset psoriatic arthritis: a comparison with younger onset disease". Ann. Rheum. Dis. 58 (4): 226–9. PMC 1752862. PMID 10364901.
- ↑ Scarpa R, Cosentini E, Manguso F, Oriente A, Peluso R, Atteno M, Ayala F, D'Arienzo A, Oriente P (December 2003). "Clinical and genetic aspects of psoriatic arthritis "sine psoriasis"". J. Rheumatol. 30 (12): 2638–40. PMID 14719207.
- ↑ Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H (August 2006). "Classification criteria for psoriatic arthritis: development of new criteria from a large international study". Arthritis Rheum. 54 (8): 2665–73. doi:10.1002/art.21972. PMID 16871531.