The Challenging Differentiation of Psoriatic Arthritis from Other Arthropathies and Nonspecific Arthralgias in Patients with Psoriasis: Results of a Cross-Sectional Rheumatologic Assessment of a Large Dermatologic Cohort

• Published in: Journal of clinical medicine 2023-09, Vol.12 (18), p.6090
• Main Authors: Floris, Alberto, Mugheddu, Cristina, Sichi, Leonardo, Dessì, Martina, Anedda, Jasmine, Frau, Alessia, Pau, Andrea, Lari, Simone Aldo, Sorgia, Jessica, Li Volsi, Laura, Paladino, Maria Teresa, Congia, Mattia, Chessa, Elisabetta, Angioni, Maria Maddalena, Ferreli, Caterina, Piga, Matteo, Atzori, Laura, Cauli, Alberto
• Format: Article
• Language: English
• Subjects: Clinical medicine; Collaboration; Dermatology; Diagnosis; Diagnosis, Differential; Disease; Fibromyalgia; Methods; Patients; Psoriasis; Psoriatic arthritis; Quality management; Questionnaires; Rheumatology; Skin; Variables
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12186090

Aiming to identify the potential challenges in the classification of musculoskeletal manifestations in patients with psoriasis (PsO), this study analyzed the outcomes of a cross-sectional rheumatologic assessment of 1057 PsO patients. In total, 209 had a previous diagnosis of psoriatic arthritis (PsA). Out of the remaining 848 subjects, 293 (35%) were classified as suspected PsA cases according to the rheumatologist’s judgment and/or Early PsA Screening Questionnaire score (EARP) ≥ 3. However, only 14% received a PsA diagnosis, 49% had a PsA-alternative diagnosis, and the remaining 37% had nonspecific arthralgias. Most of the newly diagnosed PsA patients had a symptoms duration ≥1 year (72%) and moderate disease activity (55%) with active oligoarthritis (85%), dactylitis, or enthesitis (35%) as the most frequent clinical pattern. The most frequent PsA-alternative diagnoses were osteoarthritis and fibromyalgia (44% and 41%). The only factors with significant (p < 0.05) utility in discriminating PsA from other diseases and nonspecific arthralgias were young age and EARP score with a history of morning stiffness, swollen joints, or dactylitis. These results demonstrated a high prevalence of suspected musculoskeletal symptoms in PsO patients, with, however, only a small proportion due to PsA. Close collaboration between the dermatologist and rheumatologist plays a crucial role in the differential diagnosis of PsA, as well as in monitoring nonspecific arthralgias for the potential transition to overt PsA.