Disease assessment
At each visit to the rheumatology clinic, it is
essential that disease severity is comprehensively assessed. If the patient shows signs and symptoms
of high disease activity requiring treatment
modification, assessment every three months
should be recommended. If symptoms remain
stable, assessment every six months should be
sufficient. Although management of patients with
mild psoriatic arthritis is primarily the domain of
the rheumatology team, it is important that the
extent of the individual’s psoriasis is recorded.
This will provide evidence as to whether the
disease is being controlled effectively or whether
it is progressing.
The British Society for Rheumatology
recommends that 76 joints are assessed for swelling
and 78 joints (including the hips) are assessed
for tenderness (Kyle et al 2005). Assessment of
fewer joints may mean that disease severity is
underestimated and the patient may not receive
adequate treatment to ensure disease control.
Using this assessment system, scores following
treatment can be compared with previous scores
to ensure that development of any new symptoms
is detected early.
In addition to assessment of peripheral joints,
the patient should be assessed for any involvement
of the spine. Inflammation of the back or neck will
cause pain and stiffness and could lead to a marked
restriction in mobility of the spine. The presence
of dactylitis, caused by inflammation of the joints,
tendons, bones and soft tissue, should also be
noted. Persistent dactylitis leads to destruction
of the joints in that digit and is a sign of severe
psoriatic arthritis.
Severe psoriasis can be a significant feature
of psoriatic arthritis and may necessitate a
comprehensive review using a psoriasis-specific
assessment tool such as the Psoriasis Area and
Severity Index (Carlin et al 2004). Use of such
a tool will ensure that severity of psoriasis (erythema,
induration and desquamation) and percentage area
affected are documented. A nail score will also
highlight the presence of psoriatic nail disease (Rich
and Scher 2003). This will determine the extent
of nail psoriasis by identification of any pitting,
onycholysis (separation of the nail from its bed),
hyperkeratosis, (thickening of the nail plate) and
severe nail deformity.
Disease assessmentAt each visit to the rheumatology clinic, it isessential that disease severity is comprehensively assessed. If the patient shows signs and symptomsof high disease activity requiring treatmentmodification, assessment every three monthsshould be recommended. If symptoms remainstable, assessment every six months should besufficient. Although management of patients withmild psoriatic arthritis is primarily the domain ofthe rheumatology team, it is important that theextent of the individual’s psoriasis is recorded.This will provide evidence as to whether thedisease is being controlled effectively or whetherit is progressing.The British Society for Rheumatologyrecommends that 76 joints are assessed for swellingand 78 joints (including the hips) are assessedfor tenderness (Kyle et al 2005). Assessment offewer joints may mean that disease severity isunderestimated and the patient may not receiveadequate treatment to ensure disease control.Using this assessment system, scores followingtreatment can be compared with previous scoresto ensure that development of any new symptomsis detected early.In addition to assessment of peripheral joints,the patient should be assessed for any involvementof the spine. Inflammation of the back or neck willcause pain and stiffness and could lead to a markedrestriction in mobility of the spine. The presenceof dactylitis, caused by inflammation of the joints,tendons, bones and soft tissue, should also benoted. Persistent dactylitis leads to destructionof the joints in that digit and is a sign of severepsoriatic arthritis.Severe psoriasis can be a significant featureof psoriatic arthritis and may necessitate acomprehensive review using a psoriasis-specificassessment tool such as the Psoriasis Area andSeverity Index (Carlin et al 2004). Use of sucha tool will ensure that severity of psoriasis (erythema,induration and desquamation) and percentage areaaffected are documented. A nail score will alsohighlight the presence of psoriatic nail disease (Richand Scher 2003). This will determine the extentof nail psoriasis by identification of any pitting,onycholysis (separation of the nail from its bed),hyperkeratosis, (thickening of the nail plate) andsevere nail deformity.
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