Psoriatic Arthritis Tests And Diagnosis
The diagnosis of psoriatic arthritis is largely based on your medical history and a physical exam, and laboratory tests may be used to rule out other conditions. During an appointment, your doctor will likely ask you questions about specific skin and joint symptoms and your overall well-being.
Psoriatic arthritis can damage joints over time if not controlled, so the earlier you receive a diagnosis and appropriate treatment, the better. If youre currently seeing a dermatologist for psoriasis, and you are experiencing joint pain, tell your doctor. They may refer you to a rheumatologist. If any of these symptoms seem familiar, talk to your doctor.
About 1 in 3 people with psoriasis may develop PsA.
What to expect when getting diagnosed with PsA
At your doctor appointment, be prepared to answer questions regarding your medical history as accurately as possible. Some of the questions your doctor may ask you will likely include the following:
- Which joints hurt?
- Joints at the ends of fingers and toes
During a physical exam, your doctor will look for several symptoms that are commonly associated with psoriatic arthritis:
- Tender, painful, or swollen joints
- Pain in your feet, ankles, and lower back
- An indication of psoriasis
Laboratory tests and imaging procedures:
Your doctor may order tests and procedures to help rule out other diseases or confirm your diagnosis. Some of these tests may include:
Other Tests For Psoriatic Arthritis
Researchers in a 2014 study concluded that three screening tools can help doctors determine whether you may have PsA. These included the Psoriasis and Arthritis Screening Questionnaire , Psoriasis Epidemiology Screening Tool , and Toronto Arthritis Screen .
These screenings require you to complete a questionnaire. Based on your answers, your doctor will determine if you need further care.
Your doctor may refer you to a rheumatologist if they cant make a diagnosis. A rheumatologist is a doctor who specializes in musculoskeletal conditions such as psoriatic arthritis.
What Are The Symptoms
Psoriatic arthritis can affect any joint in the body and symptoms can vary from person to person. It can develop slowly with mild symptoms, or come on quickly and be severe. The most common symptoms are:
- pain, swelling and stiffness in one or more joints
- pain and stiffness in the buttocks, lower back or neck
- pain in tendons, such as at the back of the heel or sole of the foot
- changes in nails, such as thickening, colour change or separation from the skin
- pain and redness in the eyes.
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How Can I Find The Appropriate Care I Need
Initially your GP is the first point of contact, who then should refer you on to a dermatologist/rheumatologist, if this is not already the case. If you are not happy with the advice you receive, remember you are always entitled to seek a second opinion. Remember, If you are seeing a dermatologists for your psoriasis and a rheumatologists for your arthritis make sure each is aware of this, so they can liaise and provide you with appropriate care for both conditons.
Can Psoriatic Arthritis Attack Other Organs Of The Body
Apart from the skin, nails and joints, increased cardiovascular morbidity is considered part of psoriatic disease, as is the association with inflammatory bowel disease. An itchy, red eye due to conjunctivitis is more common in people with psoriatic arthritis and some people occasionally develop a painful, red eye caused by inflammation around the pupil of the eye, which is called iritis or uveitis. Anaemia may also be found but this is the result of long-term inflammation and is not a specific feature of psoriatic arthritis.
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Blood And Pathology Tests For Arthritis
Before any tests are done, the doctor will ask you about your symptoms and will often examine you for signs of arthritis or other autoimmune features. Then tests may be done.
Your symptoms and signs on physical examination are more important for making a diagnosis than the results of the tests.
What are blood tests and pathology tests used for?
- Confirming a diagnosis of arthritis or autoimmune disorder
- Monitoring disease activity and response to treatment
- Checking for side effects from medicines
Are all types of arthritis diagnosed by blood tests?
Most forms of arthritis can be diagnosed by blood tests. The doctor may use blood tests to provide support for the diagnosis made on the symptoms and signs, or to help rule out other types of arthritis or conditions that cause similar symptoms. No blood or pathology tests may be required to diagnose some conditions such as osteoarthritis or chronic back pain.
Imaging Studies For Diagnosing Psoriatic Arthritis
In addition to laboratory tests, imaging studies can help your rheumatologist see whether the appearance of your bones and tissues suggests you could have PsA or another condition. Depending on your case and circumstances, your doctor may order one or more of the following tests:
X-ray: A radiograph image of your affected joints as well as your spine if that appears to be affected will help your doctor see marginal bone erosions, which means bone being eaten away where it meets a ligament or tendon. This would suggest PsA. Ankylosis may also be seen in very severe PsA. But a negative X-ray may simply mean the PsA is in an early stage, so additional imaging could be needed.
Ultrasound: A sonogram of the affected joints can help your doctor see disease activity and damage in tendons and ligaments. In cases of psoriatic arthritis, your doctor may see inflammation of tendons and joints or erosions where bone has been eaten away by immune cells.
MRI: Magnetic resonance imaging can be especially helpful in allowing your doctor to investigate back pain you might have associated with PsA.
Chances are, if youre seeing a rheumatologist because you have concerns about having psoriatic arthritis, youve already seen quite a few different doctors or health care providers by now. We know this process can be exhausting and exasperating. We are here for you to help make things easier.
Become part of the CreakyJoints community and follow us on and for ongoing support and education.
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How To Assess Fatigue In Psoriatic Arthritis
Unfortunately, fatigue cant be meaured with a simple lab test. And there is no single agreed-upon patient survey, questionnaire, or checklist to measure fatigue. There are many scales and patient reported outcomes that can be used. It doesnt matter which is used as long as the topic is addressed by your doctor, says Dr. Haberman.
Your doctor may use one of the following questionnaires, which are not developed specifically for PsA, to measure your fatigue:
- Fatigue numeric rating scale
- Fatigue severity scale
- Functional Assessment of Chronic Illness TherapyFatigue Scale
- Multidimensional Health Assessment Questionnaire
- Medical Outcomes Study Short Form-36
- European Quality of Life Index-5 Dimensions
At our center, we administer a questionnaire called the MDHAQ, which includes questions about fatigue, and we may administer the fatigue severity scale if needed, says Dr. Haberman. Patients may be asked to rate their level of fatigue on a numeric scale and compare their level of fatigue to prior to having PsA, or when they are stable in their treatments .
Dr. Schulman doesnt routinely give her patients any surveys/PRO instruments to measure fatigue, but says she always asks about it. However, she admits: I probably should be more consistent with this. The key is asking patients about fatigue at every visit and monitoring it over time.
Caspar Criteria For Diagnosis
Diagnosing psoriatic arthritis relies on markers in an established system called the Classification Criteria for Psoriatic Arthritis .
The criteria are each assigned a point value. Each one has a value of 1 point except for current psoriasis, which has a value of 2 points.
The criteria are as follows:
- current psoriasis outbreak
- personal or family history of psoriasis
- swollen fingers or toes, known as dactylitis
- nail problems, like separation from the nail bed
- bone growths near a joint that are visible on an X-ray
- absence of rheumatoid factor
A person must have at least 3 points based on the CASPAR criteria to be diagnosed with psoriatic arthritis.
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Physical Exam For Diagnosing Psoriatic Arthritis
The next step in diagnosing psoriatic arthritis is a thorough physical exam, which can involve a number of steps, including the following:
- Looking for signs of psoriasis in usual spots such as elbows and knees, as well as less visible places including the scalp, belly button, intergluteal cleft , palms of hands, and soles of feet
- Checking the nails of fingers and toes for abnormalities
- Applying pressure to joints for tenderness and swelling, as well as looking for redness
- Checking for tendon and ligament issues, including plantar fasciitis and Achilles tendonitis
- Checking for back mobility
- Checking for pain and inflammation along the sacroiliac joints, which is where the spine connects with your pelvis
What Blood Tests Indicate Psoriatic Arthritis
There is no single blood test that can confirm a diagnosis of psoriatic arthritis however, your doctor may order the following laboratory tests to rule out other joint conditions, such as rheumatoid arthritis, gout and osteoarthritis. Some of these tests are also used to monitor your response to psoriatic arthritis treatment.
Your hemoglobin levels and number of red blood cells may decrease if you have psoriatic arthritis.
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How Is Psoriatic Arthritis Diagnosed
A single medical test is not available to diagnose psoriatic arthritis. To find out whether you have psoriatic arthritis, your doctor will do the following:
Look at your medical records.
Ask you specific questions. This usually includes questions such as whether any of your blood relatives have psoriasis or psoriatic arthritis.
Examine your joints. This examination includes looking at your body to see whether you have swollen joints. Your doctor will gently press on the skin around certain joints to find out whether the area is tender.
Send you for medical testing. This may include x-rays and a blood test.
Before giving you a diagnosis, your doctor considers your test results and everything he or she learned while meeting with you. In case youre wondering, the result from your blood test cannot tell whether you have psoriatic arthritis. It tells your doctor whether you have inflammation throughout your body. People who have psoriatic arthritis have body-wide inflammation. Many other diseases also cause body-wide inflammation. Inflammation is a piece of the puzzle.
Because psoriatic arthritis can look like other types of arthritis, patients often see a dermatologist or rheumatologist for a diagnosis. A rheumatologist is a medical doctor who specializes in diagnosing and treating arthritis and other diseases of the joints, muscles, and bones. Rheumatologists and dermatologists generally have the most experience diagnosing and treating psoriatic arthritis.
Blood Tests For Psoriatic Arthritis
Blood tests in themselves will not confirm a PsA diagnosis. These tests are usually given to determine the presence of inflammation and to rule out other conditions.
Read on to learn what types of blood tests may be given to make a PsA diagnosis.
- Erythrocyte sedimentation rate . This gauges your bodys degree of inflammation, though not specifically for PsA. It measures the amount of red blood cells that settle in a vial of blood, which is greater when you have inflammation.
- C-Reactive protein . Your doctor may order this test to check for an elevated C-reactive protein level. This test is not specific for PsA, but it does indicate the presence of inflammation.
- Rheumatoid Factor . Presence of this antibody in your blood indicates rheumatoid arthritis . Its presence means you dont have PsA.
- Anti-Cyclic Citrullinated Peptide test. These antibodies usually indicate RA. However, their presence can occur in other forms of arthritis, and your doctor will probably test for them.
- Human leukocyte antigen B27 . This is a protein found on the surface of white blood cells in some people with PsA.
- Serum uric acid. Your doctor may take a sample of fluid from your joints to check for uric acid crystals. Elevated uric acid in the blood or crystals in bodily fluids indicate gout.
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Psoriatic Arthritis Skin And Blood Tests: Tuberculosis Test
Tuberculosis is a bacterial infection that typically affects the lungs but can also reach bones, joints, and kidneys. Symptoms include fever, night sweats, chills, coughing, weight loss, and fatigue.
People with psoriatic arthritis must have a negative TB test before they can take biologic medications, which are protein-based drugs given by injection or infusion. By suppressing the immune system, these medications may reactivate latent tuberculosis.
There are two kinds of TB tests: a skin test and a blood test. The skin test involves injecting a small amount of a protein called tuberculin into the skin of the lower arm, then checking the area around 48 to 72 hours later to see if there has been a reaction. The result depends on the size of the raised, hard area or swelling, according to the Centers for Disease Control and Prevention.
A TB blood test assesses whether the body has launched an immune response to the presence of M. tuberculosis bacteria. The test is done in a lab after a blood sample is drawn.
Frequency of Testing Doctors order a TB test before prescribing biologics and may repeat testing annually as long as a patient is taking the medication, says Cadet. She adds, Any patient who exhibits symptoms or has been exposed to TB should have an immediate TB test.
Imaging Tests For Psoriatic Arthritis
Imaging tests can help your doctor closely examine your bones and joints. Some of the imaging tests your doctor may use include:
- X rays. X-rays arent always useful in diagnosing early stage psoriatic arthritis. As the disease progresses, your doctor may use imaging tests to see changes in the joints that are characteristic of this type of arthritis.
- MRI scans. An MRI alone cant diagnose psoriatic arthritis, but it may help detect problems with your tendons and ligaments, or sacroiliac joints.
- CT scans. These are used primarily to examine joints that are deep in the body and not easily seen on x-rays, such as in the spine and pelvis.
- Ultrasounds. These tests can help determine the progression of joint involvement and pinpoint the location.
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How Is It Diagnosed
Your doctor will diagnose psoriatic arthritis from your symptoms and a physical examination. Your skin will be examined for signs of psoriasis, if you have not been diagnosed with this already. There is no specific test for psoriatic arthritis. However your doctor may order blood tests for inflammation, such as the erythrocyte sedimentation rate test. Blood tests may also help to rule out other types of arthritis. If your doctor suspects you have psoriatic arthritis you should be referred to a rheumatologist, a doctor who specialises in arthritis.
What Are The Symptoms Of Psoriatic Arthritis
The symptoms of psoriatic arthritis may be gradual and subtle in some patients in others, they may be sudden and dramatic. It may be mild, affecting only one joint or can be severe, affecting multiple joints. Not all patients experience all symptoms.
The most common symptoms of psoriatic arthritis are:
- Pain or aching, tenderness, and/or swelling in one or more joints – most commonly hands, feet, wrists, ankles, knees.
- Joint stiffness most notable in the morning or with prolonged inactivity such as sitting for a long time.
- Reduced range of motion in affected joints.
- Pain or stiffness in the lower back.
- Tenderness, pain, or swelling where tendons and ligaments attach to the bone , such as the Achilles tendon of the heel.
- Swelling of an entire finger or toe with a sausage-like appearance .
- Silver or gray scaly spots on the scalp, elbows, knees, and/or the lower spine.
- Small, round spots called papules that are raised and sometimes scaly on the arms, legs and torso.
- Pitting of the nails.
- Detachment or lifting of fingernails or toenails.
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How Is Psoriatic Arthritis Treated
Today, there are many treatment options for psoriatic arthritis. A treatment plan often includes several of the following:
Therapy : These therapies can reduce pain. They can make it easier to move and do everyday tasks. If therapy can help, your doctor will write a prescription for the type of therapy you need. Your therapist will work with your doctor and report your progress.
Patient education: Learning about psoriatic arthritis is important. The more you know, the better you can control this disease. Take time to learn the signs and symptoms. Ask your doctor what you should do when the arthritis flares. Learn about arthritis-friendly exercises and exercises that you should not do, at least for a while.
Exercise and rest: Each plays an important role. Arthritis-friendly exercises can help reduce pain, make it easier to move, and sometimes restore lost movement. Rest is important when psoriatic arthritis flares.
Devices to protect joints: Braces, splints, and supports can protect affected joints and prevent further damage. They offer support for painful areas and can stop painful movements. You should not buy one without first talking with your doctor. The device must fit you properly. It must support the area that needs support. Your doctor may recommend that a physical or occupational therapist fit you.
When psoriatic arthritis is mild, patients usually can reduce signs and symptoms with:
Tip: Take medicine after a meal
Having Psoriasis Isnt Always A Reliable Clue
Around 70 percent of people with psoriatic arthritis develop psoriasis first, but in the other 30 percent of the time, the arthritis and skin symptoms occur around the same time, people have psoriasis but dont realize it, or the psoriasis may develop later on after the arthritis-like symptoms show up. Some people can develop psoriatic arthritis without having psoriasis.
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