Psoriatic Arthritis Initial Assessment

Last updated: 19 November 2025
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Clinical Presentation

The signs and symptoms of psoriatic arthritis are as follows: Peripheral joint pain, stiffness, and swelling (in arms and legs, including elbows, wrists, hands, and feet); axial joint pain, stiffness, and swelling (in shoulders, spine, and hips); tenderness of the joint and surrounding ligaments and tendons; presence of skin and nail lesions; enthesitis, tenosynovitis, and dactylitis; and extra-articular manifestations (ie uveitis).



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Symptoms range from mild to very severe. The severity of the skin disease and the arthritis do not correlate with each other. Nail disease is commonly found in patients with psoriatic arthritis, especially those with distal interphalangeal joint involvement. Patients with axial involvement tend to have earlier onset of arthritis, more severe nail onycholysis, symptoms of inflammatory back pain, and inflammatory bowel disease (IBD). Psoriatic arthritis may start slowly with mild symptoms or may be preceded by a joint injury. 

 

Diagnosis or Diagnostic Criteria

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The diagnosis of psoriatic arthritis is based on clinical history, physical examination, and laboratory and imaging results. The following should be noted: The presence of skin and nail lesions of psoriasis; specific patterns of joint inflammation, including distal arthritis, asymmetric oligoarthritis, symmetric polyarthritis, arthritis mutilans, and spondyloarthritis (sacroiliitis and spondylitis); the mixture of subtypes and patterns of disease may vary over time; and joint stiffness lasting for >30-45 minutes in the morning or after long periods of inactivity (eg sleep or travel). Inflammatory back pain is an important clinical symptom in patients with axial disease. Other manifestations are enthesitis (inflammation at the tendon/bone interface), tenosynovitis, and dactylitis (inflamed and swollen digit or “sausage digit”).

Classification Criteria

ClASsification of Psoriatic ARthritis (CASPAR)

Patient with established inflammatory articular arthritis, that is manifested by prolonged morning or immobility-induced stiffness, tender and swollen joints, with ≥3 points from features below:

  • Current dactylitis or history of dactylitis recorded by a rheumatologist = 1 point
  • Current psoriasis = 2 points
  • Family history of psoriasis (unless there is presence of current or personal history of psoriasis) = 1 point
  • Juxta-articular new bone formation = 1 point
  • Negative rheumatoid factor = 1 point
  • Personal history of psoriasis (unless there is presence of current psoriasis) = 1 point
  • Typical psoriatic nail dystrophy, including onycholysis, pitting, and hyperkeratosis = 1 point

 

Moll and Wright Criteria

Patient with psoriasis and inflammatory arthritis, seronegative for rheumatoid arthritis, and presenting with one of the five clinical subgroups below: 

  • Polyarticular, symmetric arthritis: This affects about 15% of psoriatic arthritis patients and involves multiple symmetric pairs of joints in the hands and feet. This resembles rheumatoid arthritis
  • Oligoarticular (<5 joints), asymmetric arthritis: Most common type of psoriatic arthritis is found in >70% of patients and usually involves <5 joints and may affect any joints. Hands and feet may have enlarged “sausage digits”
  • Distal interphalangeal joint involvement: Classic type, which occurs in about 5% of cases and involves distal joints of the fingers and toes. Nail changes are common
  • Spondylitis predominant: Inflammation of the spinal column causing stiff neck, lower back pain, and sacroiliac pain. Peripheral joint disease may or may not be seen in this subgroup, which is about 5%
  • Arthritis mutilans: Severe, deforming type of psoriatic arthritis affecting about 5% of patients and affecting a few joints in the hands and feet. This is associated with pustular psoriasis

Screening

Patient-administered screening questionnaires such as Psoriasis Epidemiology Screening Tool (PEST), Psoriatic Arthritis Screening and Evaluation Tool (PASE), and Toronto Psoriatic Arthritis Screen (ToPAS) may be used for early detection of psoriatic arthritis in primary care or dermatology clinics.

Quality of Life

Specific scales such as Psoriatic Arthritis Quality of Life Index or more generic instruments (eg short form-36, Health Assessment Questionnaire [HAQ] and Functional Assessment of Chronic Illness Therapy) are used to assess the quality of life of patients with psoriatic arthritis. These tools are valid, reliable, and responsive to change.