Acute Polyarticular Pain: Evaluation and Management of Psoriatic Arthritis

Clinical Assessment and Diagnostic Approach

The American Academy of Dermatology suggests that skin manifestations, such as psoriatic plaques on knees, elbows, genitals, scalp, or nail changes, should be looked for, as 25-30% of psoriasis patients develop psoriatic arthritis 1, 2
The presence of dactylitis ("sausage digits") is highly suggestive of psoriatic arthritis, and heel/Achilles tendon tenderness indicates enthesitis, characteristic of psoriatic arthritis 1, 2
Elevated C-reactive protein levels are associated with inflammatory conditions, including psoriatic arthritis, and rheumatoid factor may be negative in psoriatic arthritis 1, 2

The American Academy of Dermatology recommends initiating methotrexate, 25mg weekly, with 1mg daily folic acid, if there is an inadequate response to NSAIDs after 4-6 weeks, for patients with suspected psoriatic arthritis 1, 2
If methotrexate fails, adding a TNF-alpha inhibitor can dramatically improve both joint and skin disease in patients with psoriatic arthritis [1, @2 geil2]
Early aggressive treatment can prevent disability in up to 50% of psoriatic arthritis patients who would otherwise develop progressive joint damage if left untreated 1, 2