Fast Five Quiz: Psoriatic Arthritis Presentation and Diagnosis

Herbert S. Diamond, MD; Eric M. Ruderman, MD; Marina Magrey, MD


January 25, 2023

Psoriatic arthritis is a heterogeneous disease with varied manifestations.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) characterized six domains of PsA which include peripheral arthritis, enthesitis, dactylitis, psoriasis, psoriatic nail disease, and axial disease. As in other spondyloarthropathies, enthesitis — which reflects inflammation at tendon or ligament insertions into bone — may be seen in psoriatic arthritis. Similarly, dactylitis (sausage digits) is suggestive of PsA and may indicate a more severe phenotype at diagnosis.

The diagnosis of psoriatic arthritis is based on the recognition of clinical and imaging features because there are no specific biomarkers. The personal history and family history of psoriasis are often positive. Inflammatory arthritis, enthesitis, dactylitis, and joint distribution provide important clues, as do extra-articular features such as inflammatory bowel disease and uveitis. Recognition of psoriatic skin lesions, particularly in the groin, umbilical area, hairline, ears, and natal (ie, intergluteal) cleft is pivotal for the diagnosis. The presence of nail lesions, including pits and onycholysis, aids in the diagnosis.

Nail involvement in psoriasis is considered a significant psychological and social problem that leads to functional impairment in affected patients. Up to 82% of patients with psoriatic arthritis have nail lesions, which can impede daily and occupational activities and contribute to a diminished quality of life. Nail involvement can also be the source of severe pain.

Learn more about the manifestations of psoriatic arthritis.


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