Differential Diagnosis of Psoriatic arthritis

Differential Diagnosis of Psoriatic arthritis

What clinical features suggest PsA rather than other polyarticular arthritic diseases such as rheumatoid arthritis?

  • Asymmetric, often oligoarticular joint involvement.
  • Absence of rheumatoid factor.
  • Significant nail pitting or nail dystrophy.
  • Involvement of DIP joints in the absence of osteoarthritis.
  • “Sausage digits” (dactylitis): seen in 30% to 50%. Due to synovitis and flexor tenosynovitis.
  • Enthesitis: seen in 35% to 40%. Most common sites: Achilles and plantar fascia insertion.
  • Family history of psoriasis or PsA.
  • Axial radiographic evidence of sacroiliitis, paravertebral ossification, and syndesmophytes.
  • Peripheral radiographic evidence of erosive arthritis with relative lack of periarticular osteopenia.
  • Synovial biopsies show increased vascularity and the presence of macrophages (CD163+), lymphocytes, and neutrophils.

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