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14-09-2021 | Psoriatic arthritis | Adis Journal Club | Article

Rheumatology and Therapy

Differentiating Psoriatic Arthritis from Osteoarthritis and Rheumatoid Arthritis: A Narrative Review and Guide for Advanced Practice Providers

Authors: William Saalfeld, Amanda M. Mixon, Jonna Zelie & Eileen J. Lydon 


Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple organ systems and is characterized by skin and joint manifestations. PsA is frequently undiagnosed and/or misdiagnosed, especially because of the similarities in clinical presentation shared with other arthritic diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). An accurate and timely diagnosis of PsA is crucial to prevent delays in optimal treatment, which can lead to irreversible joint damage and increased functional disability. Patients are usually seen by a number of different healthcare providers on their path to a diagnosis of PsA, including advanced practice providers (APPs). This review provides a comprehensive overview of the characteristic features that can be used to facilitate the differentiation of PsA from RA and OA. Detailed information on clinical manifestations, biomarkers, radiologic features, and therapeutic recommendations for PsA included here can be applied in routine clinical settings to provide APPs with the confidence and knowledge to recognize and refer patients more accurately to rheumatologists for management of patients with PsA.

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Key Summary Points

Psoriatic arthritis (PsA) is a complex disease characterized by inflammation of multiple clinical domains, including peripheral joints, skin and nails, axial joints, entheses, eyes, and digits

The similarities in clinical presentation of PsA and other rheumatic diseases such as rheumatoid arthritis (RA) or osteoarthritis (OA) can make a differential diagnosis challenging; therefore, it is crucial for primary care providers, including advanced practice providers (APPs), to be aware of characteristics and criteria indicative of a diagnosis of PsA

Characteristic features can be used to differentiate PsA from RA and OA, and early assessment, diagnosis, and treat-to-target strategies are key to the management of patients with PsA to facilitate the administration of appropriate therapy in a timely manner

Collaboration and coordinated care are key among primary care providers, APPs, and subspecialists to ensure positive outcomes for patients, controlling symptoms and disease activity, maintaining functional ability, and improving patient quality of life

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