How do you Diagnose Psoriatic Arthritis?

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Psoriatic arthritis can be a difficult condition to diagnose as there is no test which will conclusively give a diagnosis.  Some patients can have symptoms for many years before they are diagnosed.  Diagnosis often relies on a constellation of features:

  • Presence of skin psoriasis
  • Presence of swollen joints (many patients do not have this)
  • History of inflammatory back pain
  • Presence of pain and tenderness at areas where tendons, ligaments and joint capsules attach to bone (enthesitis)
  • Some patients may have raised inflammatory blood tests (CRP and ESR) but many do not.
  • Blood tests are also ordered to exclude other conditions that can cause inflammatory arthritis.  Psoriatic arthritis is a “seronegative” condition meaning that autoimmune tests are negative.  The presence of a gene called HLA B27 is more common in patients with psoriatic arthritis, however many people with the gene never develop arthritis.

If your symptoms sound suggestive then your doctor may order further tests to determine if inflammation is present.  This may include MRI scans or ultrasound.  X-rays may be ordered to determine if there has been any permanent bone and joint deformities.