PsA vs RA
•The peripheral polyarticular pattern of PsA may share several features with RA.
•Clinical features are important to differentiate seronegative (rheumatoid factor negative) RA with coincidental psoriasis from patients with peripheral PsA.
•The presence of psoriatic plaques or nail psoriasis helps to establish a diagnosis of PsA.
•Patients who display other characteristic signs of RA (i.e. rheumatoid nodules, extra-articular involvement, and high titers of rheumatoid factor) should not begiven the diagnosis of PsA.
•Involved joints in PsA are usually less tender and swollen and less symmetric in distribution than in RA.
•Dactylitis, enthesitis, and DIP joint involvement common in PsA are uncommon in RA.
PsA vs OA
•In the hands, there may be distal interphalangeal (DIP) involvement in both PsA and osteoarthritis but the classic DIP-related Heberden’s nodes in osteoarthritis are bone spurs whereas in PsA the DIP involvement is joint inflammation.
•Enthesitis, dactylitis, and sacroiliitis are generally not present in patients with osteoarthritis.
PsA vs AS
•Axial disease in PsA may present as clinically similar to AS. However, patients with PsA are often less symptomatic, have asymmetric disease, and tend to have less severe disease.
•In addition, the psoriatic plaques or nail changes present in patients with psoriatic spondylitis are absent in patients with AS.
•Axial involvement is often secondary in PsA, however PsA may present either as sacroiliitis, often asymmetric and asymptomatic, or spondylitis affecting any level of the spine in a ‘‘skip’’ fashion.
•When compared with patients with AS, patients with PsA seldom have impaired mobility or progress to ankylosis (total loss of joint space).
It is important for dermatologists to draw on both history and physical findings in making a diagnosis of an inflammatory arthritis like PsA.
Ritchlin CT, et al. N Engl J Med. 2017;376(10):957–970.
DIPJ=distal interphalangeal joint; RA=rheumatoid arthritis; PsA=psoriatic arthritis.
1. Merola JF, et al. RMD Open. 2018;4(2):e000656.
2. Tan EST, et al. Am J Clin Dermatol. 2012;13(6):375−388.
3. Sudoł-Szopińska I, et al. J Ultrason. 2016;16(64):65–77.
4. Kivelevitch D, et al. Biologics. 2014;8:169−182.
5. Brockbank JE, et al. Ann Rheum Dis. 2005;64(2):188−190.
6. Lories RJU, et al. Ann Rheum Dis. 2004;63(5):595−598.
7. Mańczak M, Gasik R. Reumatologia. 2017;55(4):201–207.
8. Radiopaedia. Rheumatoid arthritis (musculoskeletal manifestations). https://radiopaedia.org/articles/rheumatoid-arthritis-musculoskeletal-manifestations-2. Accessed 18 October 2021.
9. RheumatoidArthritis. Rheumatoid Nodules: Are Rheumatoid Nodules Dangerous? https://www.rheumatoidarthritis.org/ra/symptoms/rheumatoid-nodules/. Accessed 18 October 2021.
PsA=psoriatic arthritis; PsO=psoriasis.
1. National Psoriasis Foundation. Locations and Types: https://www.psoriasis.org/locations-and-types/. Accessed 18 October, 2021.
2. Coates LC, et al. Arthritis Rheumatol. 2016;68(5):1060−1071.
•A total of 2617 patients with PsA were enrolled in the Corrona PsA/SpA Registry at the time of this analysis, of whom 354 (13.5%) initiated a biologic at registry enrolment
•Of the 2617 patients in the overall population, 2315 (88.5%) had ≥ 1 active domain presentation at enrolment; 1814 (69.3%) presented with skin disease, 1523 (58.2%) with PA, 1042 (39.8%) with nail psoriasis, 539 (20.6%) with enthesitis, 319 (12.2%) with axial disease, and 235 (9.0%) with dactylitis.
•Regarding the frequency of active PsA domain presentations by number of domains affected among all patients with PsA, 1698 patients (64.9%) had ≥2 domain presentations, 617 (23.6%) had single-domain presentations and 302 (11.5%) had no active presentations. The most common disease presentations were skin disease only (12.7%), peripheral arthritis + skin disease (11.7%), and peripheral arthritis + nail psoriasis + skin disease (10.3%); overall, 6.8% of patients were reported to have peripheral arthritis only
•In real-world clinical practice, patients with PsA frequently presented with disease manifestations in multiple domains (most often skin, peripheral arthritis or nail), demonstrating that PsA is a heterogenous disease
The CORRONA registry was rebranded as the CorEvitas registry in March 2021.2
1. Ogdie A, et al. J Rheumatol. 2021;48(5):698–706.
2. Rheumatoid arthritis registry. CorEvitas. https://www.corevitas.com/registry/rheumatoid-arthritis. Accessed 19 October 2021.
PsA=psoriatic arthritis; RA=rheumatoid arthritis.
Jafri K, et al. Arthritis Care Res (Hoboken). 2017;69:51–57 (including supplementary appendix).
1. Mease P, et al. J Eur Acad Dermatol Venerol. 2019;33:886–892.
2. Rech J, et al. Rheumatol Adv Pract. 2020 Jul 10;4(2):rkaa033.
3. Gottlieb AB, Merola JF. J Dermatolog Treat. 2020;31(7):662–679.
4. Dures E, et al. Rheum Adv Prac. 2019;3(2):rkz022.
5. Giannelli A. Rheumatol Ther. 2019;6(1):5–21.
Gottlieb AB, Merola JF. J Dermatolog Treat. 2020;31(7):662–679.
DMARD=disease-modifying anti-rheumatic drug; NEIAA=National Early Inflammatory Arthritis Audit; PsA=psoriatic arthritis; RA=rheumatoid arthritis.
1. Dures E, et al. Rheum Adv Prac. 2019;3(2):rkz022.
2. Karmacharya P, et al. J Rheumatol. 2021;201199 [Epub ahead of print].
3. Holland R, et al. Ann Rheum Dis 2017;76:685.
Clinical features recorded as percentages, unless otherwise stated.
Clinical features in bold were also significantly increased (p≤0.05 level), compared to patients who did not experience diagnostic delay, in patients who experienced a 1- and 2- year delay in diagnosis
BMI=body mass index; CI=confidence interval; DMARD=disease-modifying antirheumatic drug; HAQ=health assessment questionnaire; PsA=psoriatic arthritis; TNF=tumour necrosis factor.
Haroon M, et al. Ann Rheum Dis. 2015;74:1045–1050.
CASPAR=Classification Criteria for Psoriatic Arthritis; PsA=psoriatic arthritis; RF=Rheumatoid Factor.
Taylor W, et al. Arthritis Rheum. 2006;54:2665–2673.
Images adapted from Sokolova MV, et al. 2020.
ACPA=anti-citrullinated antibodies; CRP=C-reactive protein; ESR=erythrocyte sedimentation rate; CRP=C-reactive protein; N/A=not applicable; PsA=psoriatic arthritis; RA=rheumatoid arthritis; RF=rheumatoid factor.
1. Juneblad K, et al. Int J Immunol Immunother. 2018,5:033.
2. Sokolova MV, et al. Arth Res Ther. 2020;22(1):26.
3. Ritchlin C. N Engl J Med. 2017;376(10):957–970.
ACR20=≥20% improvement in American College of Rheumatology score; ASDAS=Ankylosing Spondylitis Disease Activity Score; BASDAI=Bath Ankylosing Spondylitis Disease Activity Index; CPDAI=Composite Psoriatic Disease Activity Index; DAPSA=Disease Activity Index for Psoriatic Arthritis; DAS28=Disease Activity Score in 28 joints; EQ-5D=EuroQOL five dimensions questionnaire; GRACE=GRAPPA Composite Exercise; GRAPPA=Group for Research and Assessment of Psoriasis and PsA; HAQ=Health Assessment Questionnaire; HRQoL=health-related quality of life; LDI=Leeds Dactylitis Index; LEI=Leeds Enthesitis Index; MASES=Maastricht Ankylosing Spondylitis Enthesitis Score; mNAPSI=modified Nail Psoriasis Severity Index; PASI=Psoriasis Area and Severity Index; PGA=physician global assessment; PsAQoL=psoriatic arthritis quality of life; PsA=psoriatic arthritis; SPARCC=Spondyloarthritis Research Consortium of Canada.
1. McGagh D, Coates LC. Rheumatology (Oxford). 2020;59:i29–i36.
2. Eder L, et al. Ann Rheum Dis. 2010;69(12):2160–2164.
3. Wong PC, et al. Int J Rheumatol. 2012;2012:839425.
Important domains were those patients scored as ≥8 on an 11-point numerical rating scale from 0 (‘not important at all’) to 10 (‘very important’).
Orbai AM, et al. Ann Rheum Dis. 2017;76:673–680.
PD/ND refers to the percentage of discrepancy between patients and physicians reporting more severe/less severe disease activity.
DLQI=Dermatology Life Quality Index; HAQ-DI=health assessment questionnaire – disability index; ND=negative discrepancy; PASI=Psoriasis Area and Severity Index;
PD=positive discrepancy; PsA=psoriatic arthritis; SJC=swollen joint count; TJC=tender joint count.
1. Sacristán JA, et al. PLoS One. 2020;15(6):e0234705.
2. Eder L, et al. Arthritis Care Res (Hoboken). 2015;67(2):264–272.
3. Desthieux C, et al. Arthritis Care Res (Hoboken). 2017;69(10):1606–1611.
4. Furst DE, et al. Clin Rheumatol. 2017;36(9):2045–2054.
HRQoL=health-related quality of life; PsA=psoriatic arthritis.
1. Kamalaraj N, et al. Int J Rheum. 2019;22(6):967-73. 2. Ogdie A, et al. RMD Open. 2020;6(3):e001321.
All comparisons are between depressed/anxious and non-depressed/non-anxious patient groups.
ACR=American College of Rheumatology; CDAI=RA/PsA: Clinical Disease Activity Index; CI=confidence interval; DAPSA=Disease Activity in Psoriatic Arthritis; DAS28(ESR)=Disease Activity Score in 28 joints, erythrocyte sedimentation rate; EQ-5D-3L=EuroQOL 5 dimensions questionnaire-three-level version; EULAR=European League against Rheumatism; MH=mental health; MCS=mental component summary; OR=odds ratio; PsA=psoriatic arthritis; SDAI=Simple Disease Activity Index;
SF-36=36-Item Short Form Health Survey.
Michelsen B, et al. Ann Rheum Dis. 2017;76:1906–1910.
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