Characterising Alternative Diagnoses to Psoriatic Arthritis in a Rheumatology-Dermatology Combined Clinic

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis involving axial and peripheral joints and tendons that affects a subset of patients with psoriasis (PsO). PsA can be a debilitating disease and warrants prompt rheumatologic evaluation and management. The diagnosis of PsA can be challenging for the practising dermatologist as there is often an overlap in the symptoms of PsA and non-inflammatory musculoskeletal conditions such as osteoarthritis, tendonitis and myofascial pain.

The primary aim of the study is to examine psoriasis patients seen at our tertiary institution's combined rheum-derm clinic for a concern for PsA, specifically examining the revised diagnosis and the joint symptom similarities to psoriatic arthritis.

We performed a retrospective chart review of patients referred to the rheumatology-dermatology clinic (RDC) at our institution between November 2019 and March 2022. Our review included 242 patients, of which 34 (14%) were psoriasis patients specifically referred due to suspicion for PsA. Each patient underwent a comprehensive rheumatic evaluation, including history, physical examination, laboratory tests and imaging as needed.

Fourteen (41.2%) of the 34 patients referred for suspected PsA were diagnosed with non-inflammatory musculoskeletal conditions, primarily mechanical joint pain. Stiffness and/or swelling were significantly more common among patients with confirmed PsA.

These findings underscore the importance of thorough evaluation of musculoskeletal symptoms, particularly stiffness and swelling, in patients with psoriasis. Improving education on distinguishing non-inflammatory musculoskeletal conditions may enhance diagnostic accuracy and optimise referral practices.