Diagnosing psoriatic arthritis depends on three important factors:

Number one: Details of the patient’s description of his symptoms, Which we talked about in a previous article about the symptoms of psoriatic arthritis

Number two: The signs that the doctor finds when he examines the patient that are specific for this disease and that confirm its diagnosis, if present

Number three: Some imaging procedures that the doctor order if needed. These include X-rays, joint ultrasound or MRIs. Signs of imaging procedures, if present, can be so specific to the diagnosis of psoriatic arthritis and can help to very smoothly differentiate it from other autoimmune rheumatic diseases. Psoriatic arthritis signs take time to appear on plain X-rays. We mostly rely on the other imaging procedures especially joint ultrasound.

 

Of course, the presence of psoriasis of the skin will help in the diagnosis. But we must know that it is not a rule that any pain in the joints in a patient who has psoriasis in the skin must be psoriatic arthritis. Why? Because the pattern of joint affection is a more important factor and it sorts out this diagnosis more than anything else. But again, the presence of skin psoriasis is still a sign that has a lot of weight while we make the diagnosis very specially if you have skin psoriasis and arthritis, both starting at the same time.

 

A final and very important point in diagnosing psoriatic arthritis: What is the role of labs, blood tests in confirming the diagnosis of psoriatic arthritis? The answer is: they have no role in confirming the diagnosis. We cannot consider that any lab test is specific or diagnostic for psoriatic arthritis.

 

Quite the opposite, in diagnosing psoriatic arthritis, some tests may be misleading and the clinical picture remains the most important factor for diagnosis more than anything else.

Examples of such blood tests include the ESR test, the erythrocyte sedimentation rate that should reflect ongoing inflammation in the body if it is elevated. Well, it is high in only forty percent of patients with psoriatic arthritis.

Also, the blood test for antibodies like rheumatoid factor and anti-CCP and anti-nuclear antibodies, if you are familiar with those names, those tests are more important in the diagnosis of other types of arthritis and not psoriatic arthritis. Nevertheless, sometimes they will be positive in psoriatic arthritis. This should not confuse the rheumatologist anyway as he relies on the clinical picture and clinical presentation more than anything else.

 

Summary of diagnosis of psoriatic arthritis: your symptoms, our examination of your joints and the imaging procedures that we request like joint ultrasound if needed.

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This post was prepared and published by  Dr. Hatem Eleishi. Dr. Hatem Eleishi is a professor of rheumatology at Cairo university (Egypt) and is especially dedicated to supporting arthritis patients with online educational videos and articles about arthritis causes and treatment. He also runs a rheumatology clinic in Cairo and a center for online medical consultations that, in addition to providing online rheumatology consultations, also provides online medical consultations in several different medical specialties by expert consultants from Egypt, Canada and the United States.

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