{"id":2473,"date":"2009-07-30T12:21:40","date_gmt":"2009-07-30T12:21:40","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/reupsa\/"},"modified":"2025-05-14T19:09:18","modified_gmt":"2025-05-14T19:09:18","slug":"reupsa","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/reupsa\/","title":{"rendered":"Diagnostic Criteria for Psoriatic Arthritis (PsA)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>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.<\/p>\n<p><!--more--><\/p>\n<p><strong>Moll and Wright Criteria and Specific Features of PsA<\/strong><\/p>\n<p>The original diagnostic criteria of Moll and Wright are the simplest and the most frequently used in current studies. The criteria are:<\/p>\n<ul>\n<li>An inflammatory arthritis (peripheral arthritis and\/or sacroiliitis or spondylitis)<\/li>\n<li>The presence of psoriasis<\/li>\n<li>The (usual) absence of serological tests for rheumatoid factor.<\/li>\n<\/ul>\n<p>Using these diagnostic criteria Moll and Wright described five subgroups of PsA: distal interphalangeal (DIP) joint only, asymmetrical oligoarthritis, polyarthritis, spondylitis, and arthritis mutilans.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Criteria for psoriatic arthritis (PsA) proposed by Bennett<\/strong><\/p>\n<p><strong>Mandatory<\/strong><\/p>\n<ul>\n<li>Clinically apparent psoriasis (skin or nails)<\/li>\n<li>Pain and soft tissue swelling and\/or limitation of motion in at least one joint observed by a physician for six weeks or longer<\/li>\n<\/ul>\n<p><strong>Supportive<\/strong><\/p>\n<ul>\n<li>Pain and soft tissue swelling and\/or limitation of motion in one or more other joints observed by a physician<\/li>\n<li>Presence of an inflammatory arthritis in a distal interphalangeal joint. Specific exclusions: Bouchard\u2019s or Heberden\u2019s nodes<\/li>\n<li>Presence of \u2018\u2018sausage\u2019\u2019 fingers or toes<\/li>\n<li>An asymmetrical distribution of arthritis in the hands and feet<\/li>\n<li>Absence of subcutaneous nodules<\/li>\n<li>A negative test for rheumatoid factor in the serum<\/li>\n<li>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<\/li>\n<li>A synovial biopsy showing hypertrophy of the synovial lining with a predominantly mononuclear cell infiltration and an absence of granuloma or tumour<\/li>\n<li>Peripheral radiographs showing erosive arthritis of small joints with a relative lack of osteoporosis. Specific exclusion: erosive osteoarthritis<\/li>\n<li>Axial radiographs showing any of the following: sacroiliitis, syndesmophytes, paravertebral ossification<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Definite PsA: mandatory plus six supportive<br \/>\nProbable PsA: mandatory plus four supportive<br \/>\nPossible PsA: mandatory plus two supportive<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Criteria for psoriatic arthritis proposed by Vasey and Espinoza<\/strong><\/p>\n<p>Psoriatic arthritis is defined as criterion I plus one from either criterion II or III<\/p>\n<p>Criterion I: Psoriatic skin or nail involvement<br \/>\nCriterion II: Peripheral pattern<\/p>\n<ol>\n<li>Pain and soft tissue swelling with or without limitation of movement of the distal interphalangeal joint for over four weeks<\/li>\n<li>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<\/li>\n<li>Symmetrical peripheral arthritis for over four weeks, in the absence of rheumatoid factor or subcutaneous nodules<\/li>\n<li>Pencil in cup deformity, whittling of terminal phalanges, fluffy periostitis and bony ankylosis<\/li>\n<\/ol>\n<p>Criterion III: Central pattern<\/p>\n<ol>\n<li>Spinal pain and stiffness with the restriction of motion present for over four weeks<\/li>\n<li>Grade 2 symmetric sacroiliitis according to the New York criteria<\/li>\n<li>Grade 3 or 4 unilateral sacroiliitis<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><strong>Modified ESSG criteria for psoriatic arthritis<\/strong><\/p>\n<p>Inflammatory spinal pain<br \/>\n<em> or<\/em><br \/>\nSynovitis (either asymmetrical or predominantly lower limb)<br \/>\n<em> and<\/em><br \/>\nOne or more of the following:<\/p>\n<ul>\n<li>Positive family history of psoriasis<\/li>\n<li>Psoriasis<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Modified McGonagle criteria for psoriatic arthritis<\/strong><\/p>\n<p>Psoriasis or family history of psoriasis<br \/>\nPlus any one of:<\/p>\n<ul>\n<li>Clinical inflammatory enthesitis<\/li>\n<li>Radiographic enthesitis (replaces MRI evidence of enthesitis)<\/li>\n<li>Distal interphalangeal joint disease<\/li>\n<li>Sacroiliitis\/spinal inflammation<\/li>\n<li>Uncommon arthropathies (SAPHO, spondylodiscitis, arthritis mutilans, onycho-pachydermo-periostitis, chronic multifocal recurrent osteomyelitis)<\/li>\n<li>Dactylitis<\/li>\n<li>Monoarthritis<\/li>\n<li>Oligoarthritis (four or less swollen joints)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Psoriatic arthritis criteria of Fourni\u00e9<\/strong><\/p>\n<p>Cut-off for diagnosis of psoriatic arthritis = 11 points<\/p>\n<p>Criteria<\/p>\n<ul>\n<li>Arthritis of a distal interphalangeal joint (3 points)<\/li>\n<li>Asymmetrical monarthritis or oligoarthritis (3 point)<\/li>\n<li>Buttock pain, heel pain, spontaneous anterior chest wall pain, or diffuse inflammatory pain in the entheses (2 points)<\/li>\n<li>Radiological criterion (5 points) (any one criterion present)<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul style=\"list-style-type: circle;\">\n<li>Erosion of distal interphalangeal joint<\/li>\n<li>Osteolysis<\/li>\n<li>Ankylosis<\/li>\n<li>Juxta-articular periostitis<\/li>\n<li>Phalangeal tuft resorption<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Human leucocyte antigen (HLA)-B16 (38, 39) or B17 (6 points)<\/li>\n<li>Negative rheumatoid factor (4 points)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>The Classification Criteria for Psoriatic Arthritis (CASPAR) Criteria<\/strong><\/p>\n<p>The CASPAR criteria for psoriatic arthritis consist of inflammatory articular disease (joint, spine, or entheseal) with &gt;\/= <strong>3 points<\/strong> from the above categories. The sensibility is 98.7% and the specificity is 91.4%.<\/p>\n<div class=\"table_info\">\n<ol>\n<li>Evidence of current psoriasis, a personal history of psoriasis, or a family history of psoriasis <strong>(2 points)<\/strong>\n<ul>\n<li>Current psoriasis is defined as psoriatic skin or scalp disease present today as judged by a rheumatologist or dermatologist.\u2020<\/li>\n<li>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.<\/li>\n<li>A family history of psoriasis is defined as a history of psoriasis in a first- or second-degree relative according to patient report.<strong><br \/>\n<\/strong><\/li>\n<\/ul>\n<\/li>\n<li>Typical psoriatic nail dystrophy including onycholysis, pitting, and hyperkeratosis observed on current physical examination <strong>(1 point)<\/strong><\/li>\n<li>A negative test result for the presence of rheumatoid factor by any method except latex <strong>(1 point)<\/strong><\/li>\n<li>Either current dactylitis, defined as swelling of an entire digit, or a history of dactylitis recorded by a rheumatologist <strong>(1 point)<\/strong><\/li>\n<li>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 <strong>(1 point)<\/strong><\/li>\n<\/ol>\n<div class=\"table_info\">\u2020 Current psoriasis is assigned a score of 2; all other features are assigned a score of 1.<\/div>\n<div class=\"table_info\"><\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med. 2017 Mar 9;376(10):957-970. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28273019\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Brent LH.Inflammatory arthritis: an overview for primary care physicians.Postgrad Med. 2009 Mar;121(2):148-62. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19332973\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>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. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16871531\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Helliwell PS, Taylor WJ. Classification and diagnostic criteria for psoriatic arthritis. Ann Rheum Dis. 2005 Mar;64 Suppl 2:ii3-8. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15708931\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Jul 30, 2009<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[45],"tags":[1069,1068,16,15,14,13,1425,1424,1423,1070],"class_list":["post-2473","post","type-post","status-publish","format-standard","hentry","category-rheumatology","tag-arthritis","tag-artritis","tag-criteria","tag-criterios","tag-diagnostic","tag-diagnostico","tag-psoriasica","tag-psoriasis","tag-psoriatic","tag-rheumatology"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2473","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2473"}],"version-history":[{"count":3,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2473\/revisions"}],"predecessor-version":[{"id":8963,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2473\/revisions\/8963"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2473"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2473"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2473"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}