Unifying Concepts

Diagnostic Criteria for Psoriatic Arthritis (PsA)

Psoriatic arthritis is a type of arthritis that develops in some people with the skin condition psoriasis. It typically causes affected joints to become inflamed (swollen), stiff and painful.

Moll and Wright Criteria and Specific Features of PsA

The original diagnostic criteria of Moll and Wright are the simplest and the most frequently used in current studies. The criteria are:

  • An inflammatory arthritis (peripheral arthritis and/or sacroiliitis or spondylitis)
  • The presence of psoriasis
  • The (usual) absence of serological tests for rheumatoid factor.

Using these diagnostic criteria Moll and Wright described five subgroups of PsA: distal interphalangeal (DIP) joint only, asymmetrical oligoarthritis, polyarthritis, spondylitis, and arthritis mutilans.


Criteria for psoriatic arthritis (PsA) proposed by Bennett


  • Clinically apparent psoriasis (skin or nails)
  • Pain and soft tissue swelling and/or limitation of motion in at least one joint observed by a physician for six weeks or longer


  • Pain and soft tissue swelling and/or limitation of motion in one or more other joints observed by a physician
  • Presence of an inflammatory arthritis in a distal interphalangeal joint. Specific exclusions: Bouchard’s or Heberden’s nodes
  • Presence of ‘‘sausage’’ fingers or toes
  • An asymmetrical distribution of arthritis in the hands and feet
  • Absence of subcutaneous nodules
  • A negative test for rheumatoid factor in the serum
  • An inflammatory synovial fluid with a normal or increased C3 or C4 level and an absence of infection (including acid fast bacilli) and crystals of monosodium urate or pyrophosphate
  • A synovial biopsy showing hypertrophy of the synovial lining with a predominantly mononuclear cell infiltration and an absence of granuloma or tumour
  • Peripheral radiographs showing erosive arthritis of small joints with a relative lack of osteoporosis. Specific exclusion: erosive osteoarthritis
  • Axial radiographs showing any of the following: sacroiliitis, syndesmophytes, paravertebral ossification


Definite PsA: mandatory plus six supportive
Probable PsA: mandatory plus four supportive
Possible PsA: mandatory plus two supportive


Criteria for psoriatic arthritis proposed by Vasey and Espinoza

Psoriatic arthritis is defined as criterion I plus one from either criterion II or III

Criterion I: Psoriatic skin or nail involvement
Criterion II: Peripheral pattern

  1. Pain and soft tissue swelling with or without limitation of movement of the distal interphalangeal joint for over four weeks
  2. Pain and soft tissue swelling with or without limitation of motion of the peripheral joints involved in an asymmetrical peripheral pattern for over four weeks. This includes a sausage digit
  3. Symmetrical peripheral arthritis for over four weeks, in the absence of rheumatoid factor or subcutaneous nodules
  4. Pencil in cup deformity, whittling of terminal phalanges, fluffy periostitis and bony ankylosis

Criterion III: Central pattern

  1. Spinal pain and stiffness with the restriction of motion present for over four weeks
  2. Grade 2 symmetric sacroiliitis according to the New York criteria
  3. Grade 3 or 4 unilateral sacroiliitis


Modified ESSG criteria for psoriatic arthritis

Inflammatory spinal pain
Synovitis (either asymmetrical or predominantly lower limb)
One or more of the following:

  • Positive family history of psoriasis
  • Psoriasis


Modified McGonagle criteria for psoriatic arthritis

Psoriasis or family history of psoriasis
Plus any one of:

  • Clinical inflammatory enthesitis
  • Radiographic enthesitis (replaces MRI evidence of enthesitis)
  • Distal interphalangeal joint disease
  • Sacroiliitis/spinal inflammation
  • Uncommon arthropathies (SAPHO, spondylodiscitis, arthritis mutilans, onycho-pachydermo-periostitis, chronic multifocal recurrent osteomyelitis)
  • Dactylitis
  • Monoarthritis
  • Oligoarthritis (four or less swollen joints)


Psoriatic arthritis criteria of Fournié

Cut-off for diagnosis of psoriatic arthritis = 11 points


  • Arthritis of a distal interphalangeal joint (3 points)
  • Asymmetrical monarthritis or oligoarthritis (3 point)
  • Buttock pain, heel pain, spontaneous anterior chest wall pain, or diffuse inflammatory pain in the entheses (2 points)
  • Radiological criterion (5 points) (any one criterion present)
    • Erosion of distal interphalangeal joint
    • Osteolysis
    • Ankylosis
    • Juxta-articular periostitis
    • Phalangeal tuft resorption
  • Human leucocyte antigen (HLA)-B16 (38, 39) or B17 (6 points)
  • Negative rheumatoid factor (4 points)


The Classification Criteria for Psoriatic Arthritis (CASPAR) Criteria

The CASPAR criteria for psoriatic arthritis consist of inflammatory articular disease (joint, spine, or entheseal) with >/= 3 points from the above categories. The sensibility is 98.7% and the specificity is 91.4%.

  1. Evidence of current psoriasis, a personal history of psoriasis, or a family history of psoriasis (2 points)
    • Current psoriasis is defined as psoriatic skin or scalp disease present today as judged by a rheumatologist or dermatologist.†
    • A personal history of psoriasis is defined as a history of psoriasis that may be obtained from a patient, family physician, dermatologist, rheumatologist, or other qualified health care provider.
    • A family history of psoriasis is defined as a history of psoriasis in a first- or second-degree relative according to patient report.
  2. Typical psoriatic nail dystrophy including onycholysis, pitting, and hyperkeratosis observed on current physical examination (1 point)
  3. A negative test result for the presence of rheumatoid factor by any method except latex (1 point)
  4. Either current dactylitis, defined as swelling of an entire digit, or a history of dactylitis recorded by a rheumatologist (1 point)
  5. Radiographic evidence of juxta-articular new bone formation appearing as ill-defined ossification near joint margins (but excluding osteophyte formation) on plain radiographs of the hand or foot (1 point)
† Current psoriasis is assigned a score of 2; all other features are assigned a score of 1.



  1. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med. 2017 Mar 9;376(10):957-970. [Medline]
  2. Brent LH.Inflammatory arthritis: an overview for primary care physicians.Postgrad Med. 2009 Mar;121(2):148-62. [Medline]
  3. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H; CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73. [Medline]
  4. Helliwell PS, Taylor WJ. Classification and diagnostic criteria for psoriatic arthritis. Ann Rheum Dis. 2005 Mar;64 Suppl 2:ii3-8. [Medline]


Created Jul 30, 2009

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