Psoriatic Arthritis - Diagnosis

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How does a doctor diagnose psoriatic arthritis?

Psoriatic arthritis is a diagnosis made mainly on clinical grounds, based on the finding of psoriasis and the typical inflammatory arthritis of the spine and/or other joints. There is no laboratory test to diagnose psoriatic arthritis. Blood tests such as sedimentation rate may show an abnormal elevated result and merely reflect presence of inflammation in the joints and other organs of the body. Other blood tests, such as rheumatoid factor, are obtained to exclude rheumatoid arthritis. When one or two large joints (such a knees) are inflamed, arthrocentesis can be performed. Arthrocentesis is an office procedure whereby a sterile needle is used to withdraw (aspirate) fluid from the inflamed joints. The fluid is then analyzed for inflammation, infection, gout crystals, and other inflammatory conditions. X-rays may show changes of cartilage or bone injury indicative of arthritis of the spine, sacroiliac joints, and/or joints of the hands. Typical X-ray findings include bony erosions resulting from arthritis, but these may not be present in early disease. MRI scanning is sometimes used to identify early erosion of joints. The blood test for the genetic marker HLA-B27, mentioned above, is often performed. This marker can be found in over 50% of patients with psoriatic arthritis who have spine inflammation.

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Comment from: Gould88, 35-44 Female (Patient) Published: November 27

I am a 44 years old RN (registered nurse), practicing for 25 years. I have had flares of mild to moderate scalp psoriasis since age 9. At age 12, I had debilitating pain in my knees and could barely walk for a few weeks. The doctor diagnosed me as "needy" - implied that I "over-exaggerated" my pain, and told my parents to spend more quality time with me. Frequent asthma attacks and bouts of severe pleurisy would put me on steroid treatment - and pain always got better. I've exercised since I was 13 just because I noticed how much better I felt when I did. Approximately 2 years ago, knees became severe, couldn't continue with running or walking for any length of time, I have put all energy since then into making it through 2, 12 hour shifts at hospital a week, then I have to rest. I have progressive fatigue- the doctors said it was stress and I'm "that age." Elbows are hurting now, hips hurting bilateral, and 6 weeks ago I "hurt" my back helping a patient. MRI showed significant spondylitis/sacroiliitis of lower spine. Progress of recovery has been slow! Out of desperation, feeling that I was being "over-reactive" to pain and maybe I was depressed, I started researching and trying to put the pieces of the puzzle together. I came across psoriasis foundation website, and saw nail changes that looked just like mine! I looked further and realized, I am legitimately hurting! I am not crazy! I am not needy! I have psoriatic arthritis! I discussed my revelation with the doctor this morning and he agrees; and I see a rheumatologist in 2 weeks. I'm a little scared about future, but also hopeful that at least now I'm validated after all these years.

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Comment from: colleen, 45-54 (Patient) Published: February 20

I was diagnosed 6 years ago after being misdiagnosed for 5 years. I now have fibromyalgia and psoriatic arthritis systemically. My physician diagnosed me in 5 minutes after looking at my rashes, hands and feet. I could not tolerate methotrexate, but have been on Enbrel. I just started on Humira but have problems with infections and some of my family who are not supportive.

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