A person with psoriatic arthritis should immediately consult the doctor for accurate diagnosis and appropriate treatment as it affects various joints of ankle, knees, feet, hands and fingers and causes inflammation of joints which results in swollen, red, warm and painful joints. You should opt for early diagnosis of psoriatic arthritis; otherwise this condition can cause serious joint damage and deformities.
The diagnosis of psoriatic arthritis is based on observation of symptoms, physical examination, medical history, blood tests and imaging tests. The doctor will ask you a questions about the medical history, allergies, other illness and family history. During physical examination of the patient, the doctors check for presence of nail and skin changes along with joint damage if any.
After physical examination, some laboratory tests are prescribed by the doctor such as erythrocyte sedimentation rate (ESR) which may be elevated due to inflammation of the joints in psoriatic arthritis. Determination of serum uric acid is another blood test of which raised levels are suggestive of psoriatic arthritis. Besides this, the blood test for HLA-B27, a genetic marker, may be positive in about 50% of patients having psoriatic arthritis with spine inflammation. Some blood tests are performed to rule out the presence of other types of arthritis. For example, determination of rheumatoid factor is done to rule out the possibility of rheumatoid arthritis.
When one or two large joints such as knees are involved and inflamed, arthrocentesis is suggested which involves aspiration of fluid from the inflamed joints with the help of a sterile needle. The joint fluid is analyzed for the presence of gout crystals, infection and other inflammatory conditions.
The imaging tests such as x-ray, MRI (Magnetic Resonance Imaging) and CT (Computerized Tomography) scan are also beneficial for the diagnosis of psoriatic arthritis. Typical x-ray findings in psoriatic arthritis are the changes in cartilage or bone injury which indicates the arthritis of sacroiliac joints, spine and hands. CT scan of pelvis is suggested for the inflammation of hip, pelvis or spine, while MRI scan is performed to detect the involvement of joints especially of feet and hands.
Psoriatic arthritis is usually mild but chronic condition and with proper treatment, the symptoms like joint stiffness and pain can be relieved and the skin problems can be controlled. However, some people have more serious symptoms and they may need combination of medications to manage the symptoms and prevent the joint damage. The factors that may predict a worse prognosis are a strong family history of psoriasis, extensive skin involvement, polyarticular or erosive disease and expression of HLA-B27, -DR3 or –DR4 alleles.
