{"id":4345,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/psoriaticarthritis\/"},"modified":"2024-10-07T11:05:12","modified_gmt":"2024-10-07T10:05:12","slug":"psoriaticarthritis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/psoriaticarthritis\/","title":{"rendered":"Psoriatic Arthritis"},"content":{"rendered":"\n<p>The key clinical features are:<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">History<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Joint pain, stiffness and swelling affecting the PIP and DIP joints of the hands, feet and large joints (figure 1).Symmetrical\/asymmetrical.<\/li>\n\n\n\n<li>Early morning stiffness (typically &gt;30 minutes)<\/li>\n\n\n\n<li>Inactivity gelling (stiffness after a period of inactivity)<\/li>\n\n\n\n<li>History of psoriasis\/family history of psoriasis<\/li>\n\n\n\n<li>May have inflammatory back pain symptoms<\/li>\n\n\n\n<li>May have IBD\/uveitis\/iritis<\/li>\n<\/ul>\n\n\n\n<p><strong>Examination<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Joint swelling and tenderness<\/li>\n\n\n\n<li>Nail changes e.g., pitting<\/li>\n\n\n\n<li>Psoriasis<\/li>\n<\/ul>\n\n\n\n<p><strong>Investigations<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FBC ,UE,LFT,CRP\/ESR (may be normal)<\/li>\n\n\n\n<li>Anti-CCP antibodies (typically negative)<\/li>\n\n\n\n<li>X-ray of hands or feet (erosions)<\/li>\n<\/ul>\n\n\n\n<p><strong>M.A &amp; S.R\/H.B. 25-01-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">When to refer:<\/h4>\n\n\n\n<p>Patients suspected of having psoriatic arthritis should be referred to the rheumatology service<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI Gateway &gt; Rheumatology &gt; WGH<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Initial management<\/h4>\n\n\n\n<p>Treat symptoms with NSAID \/ and or analgesics pending clinic review.<\/p>\n\n\n\n<p>Please avoid giving corticosteroids<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Main differential diagnoses<\/h4>\n\n\n\n<p>There is bony swelling of the DIP and PIP and 1<sup>st<\/sup>&nbsp;CMC joints of the hands rather than synovitis. Morning stiffness is not prominent. Radiographs show OA change. <\/p>\n\n\n\n<p>More details on the&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology\/osteoarthritis\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology\/osteoarthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Osteoarthritis<\/a>&nbsp;Refhelp page<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>\u200b<a href=\"https:\/\/www.versusarthritis.org\/about-arthritis\/conditions\/psoriatic-arthritis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Psoriatic arthritis | Psoriatic arthritis | Causes, symptoms, treatments (versusarthritis.org)<\/a><\/p>\n\n\n\n<p><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>The key clinical features are: History Examination Investigations M.A &amp; S.R\/H.B. 25-01-24<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4395,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[627],"class_list":["post-4345","page","type-page","status-publish","hentry","category-psoriaticarthritis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/rheumatology\/psoriaticarthritis\/\" rel=\"tag\">Psoriatic Arthritis<\/a>","rttpg_excerpt":"The key clinical features are: History Examination Investigations M.A &amp; S.R\/H.B. 25-01-24","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4345","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4345"}],"version-history":[{"count":11,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4345\/revisions"}],"predecessor-version":[{"id":21129,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4345\/revisions\/21129"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4395"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4345"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4345"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}