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In general, a diagnosis of psoriatic
arthritis is made on the basis of four features:
medical history
physical examination of joints
laboratory and blood tests
X-rays
Medical
History
Since most patients with psoriatic
arthritis will initially have psoriasis lesions, a medical
history and physical examination are both very important
in diagnosing psoriatic arthritis.
Physical
Examination
In a person presenting with swollen,
tender joints, an examination of the skin for typical
lesions of psoriasis and nail changes can indicate the
possibility of psoriatic arthritis. In addition to the
skin exam, your doctor may make other assessments, such
as taking your blood pressure, and listening to and
examining your heart, lungs and abdomen.
Remember to discuss any joint
symptoms with your family doctor and/or dermatologist.
They will help determine whether you have psoriatic
arthritis and might subsequently refer you to a rheumatologist.
Your doctor will need to carefully
examine your joints to look for changes in the joints,
and identify the number of joints affected. Many dermatologists
refer patients to a rheumatologist for detailed examination
of the joints and further testing.
Your doctor will look at, feel
and move your joints to assess the problem, and determine
both the number of joints and the extent to which they
are affected. Clues that suggest psoriatic arthritis
include:
the presence of hot, red joints
sausage fingers and toes (dactylitis)
different joints on opposite
sides of the body (asymmetrical) are affected
distal interphalangeal (DIP)
joints are affected
Psoriasis Hands
Feeling the joints gives important information about the
presence of warmth, swelling and a grinding sensation
known as crepitus. Warmth
in a joint can indicate inflammation, which is found
in psoriatic arthritis as well as several other types
of arthritis. Swelling in a joint can be due to several
causes, e.g., thickening of the lining in the joints
(known as synovium) or bony overgrowth. Crepitus refers
to the sensation of crunching or grinding in a joint,
which you can feel if your hand is placed over the joint
while it is in motion.
Your doctor might feel your joints
to determine whether you have pain when pressure is
applied. In addition, inflammation at those sites where
the tendon inserts into the bone is characteristic of
psoriatic arthritis.
Finally, your doctor might
try to move your joints through a range of movement,
to see if they are normal. Those with deformities from
psoriatic arthritis could have a limited range of movement.
Your doctor will also evaluate the ability and strength
of your grip.
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