The key clinical features are:
History
- Joint pain, stiffness and swelling affecting the PIP and DIP joints of the hands, feet and large joints (figure 1).Symmetrical/asymmetrical.
- Early morning stiffness (typically >30 minutes)
- Inactivity gelling (stiffness after a period of inactivity)
- History of psoriasis/family history of psoriasis
- May have inflammatory back pain symptoms
- May have IBD/uveitis/iritis
Examination
- Joint swelling and tenderness
- Nail changes e.g., pitting
- Psoriasis
Investigations
- FBC ,UE,LFT,CRP/ESR (may be normal)
- Anti-CCP antibodies (typically negative)
- X-ray of hands or feet (erosions)
M.A & S.R/H.B. 25-01-24
When to refer:
Patients suspected of having psoriatic arthritis should be referred to the rheumatology service
How to refer:
SCI Gateway > Rheumatology > WGH
Initial management
Treat symptoms with NSAID / and or analgesics pending clinic review.
Please avoid giving corticosteroids
Main differential diagnoses
There is bony swelling of the DIP and PIP and 1st CMC joints of the hands rather than synovitis. Morning stiffness is not prominent. Radiographs show OA change.
More details on the Osteoarthritis Refhelp page
