Prompt diagnosis key in improving outcomes in psoriatic arthritis

If left untreated psoriatic arthritis (PsA) can result in progressive, irreversible joint damage causing chronic pain and disability. It is a chronic, autoimmune inflammatory condition that can affect up to 30% of patients with psoriasis. PsA is a multisystem disease affecting other organs such as the eyes, gut and tendons. It is associated with multiple comorbidities such as diabetes mellitus, cardiovascular disease and metabolic syndrome. Early diagnosis is crucial as structural joint damage can occur within the first two years of disease onset. Symptoms in PsA patients have traditionally been divided into six domains: peripheral arthritis, enthesitis, dactylitis, axial disease, psoriasis and nail disease. Patients do not need to have symptoms in all domains for diagnosis, but examination of these six domains is important when assessing patients, prior to making a referral to rheumatology. If PsA is suspected in primary care, routine blood tests should be requested to check for anaemia of chronic disease and raised inflammatory markers. Plain radiographs of hands and feet should be requested prior to referral, although classical changes do not occur early in the disease. If GPs suspect PsA, prompt referral is paramount. Patients should be referred if they have persistent joint symptoms, a positive screening questionnaire (PEST), joint swelling, dactylitis or enthesitis, and/or inflammatory back pain.