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Clinical manifestations and diagnosis of psoriatic arthritis

Dafna D Gladman, MD, FRCPC
Christopher Ritchlin, MD, MPH
Section Editor
Joachim Sieper, MD
Deputy Editor
Paul L Romain, MD


Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis [1]. It was initially considered a variant of rheumatoid arthritis, but subsequently emerged as a distinct clinical entity [2]. Historically, seronegativity for rheumatoid factor (RF) had been a requirement for the diagnosis; however, over 10 percent of patients with uncomplicated psoriasis and up to 15 percent of the normal population have RF present in their serum. As a result, the term “usually seronegative” arthritis is most suitable for PsA [3,4].

The clinical manifestations and diagnosis of PsA are discussed here. The pathogenesis and treatment of this disorder and overviews of the clinical manifestations, diagnosis, and treatment of psoriasis are presented separately. (See "Pathogenesis of psoriatic arthritis" and "Treatment of psoriatic arthritis" and "Epidemiology, clinical manifestations, and diagnosis of psoriasis" and "Treatment of psoriasis".)


Psoriatic arthritis (PsA) affects women and men equally, with an incidence of approximately 6 per 100,000 per year and a prevalence of about 1 to 2 per 1000 in the general population [1,3,5-8]. Estimates of the prevalence of psoriatic arthritis among patients with psoriasis have ranged from 4 to 30 percent [8-13]. These estimates have some limitations, as indicated by a 2008 systematic review of reports from 1987 to 2006 that found marked variability of the reported incidence and prevalence estimates in the general population and suggested that different definitions, as well as geography, may contribute to the variability [14]. Similar concerns apply to the analyses of patients with psoriasis.

A multicenter trial in Europe of 1560 patients with psoriasis estimated that 31 percent of the patients would have PsA after 30 years of psoriasis [15]. In this study, the risk of developing PsA did not decrease with time. Another study of 1511 patients with psoriasis from academic and community dermatology practices in Germany identified 21 percent of the patients as having PsA [16]. Using the internationally agreed-upon Classification Criteria for Psoriatic Arthritis (CASPAR) criteria (see 'Classification criteria' below), which were first proposed in 2006, the estimated prevalence of PsA among patients with psoriasis in two large general practices in the United Kingdom was 14 percent [17]. A prospective, four-year study of patients with psoriasis who did not have PsA at presentation found an incidence of newly diagnosed PsA, also based upon the CASPAR criteria, of almost 2 percent per year [18]. In this study, the severity of psoriasis, the presence of nail lesions, and the presence of scalp and intergluteal lesions were more likely to occur in those with PsA.

The frequency of inflammatory back pain and axial spondyloarthritis in patients with psoriasis were examined using data from the US Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES) for 2009 to 2010, which included 148 patients with psoriasis among 5103 patients who were queried regarding issues related to back pain [19]. The patients with psoriasis exhibited a significantly higher prevalence of inflammatory back pain and spondyloarthritis (about 17 versus 5 and 14 versus 2 percent, respectively).


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Literature review current through: Sep 2016. | This topic last updated: Feb 12, 2016.
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