Psoriatic Disease Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Psoriatic Disease Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
Clin Immunol. 2020 May;214:108390. doi: 10.1016/j.clim.2020.108390. Epub 2020 Mar 18.
Psoriatic arthritis (PsA) is a chronic heterogeneous inflammatory musculoskeletal disease. The non-specific and often subtle manifestations make early diagnosis and subsequent treatment challenging. In the absence of diagnostic criteria and biomarkers, the diagnosis is often delayed leading to poor long-term outcomes. In addition, the differential diagnosis of a patient presenting with arthritis in the setting of skin psoriasis is wide due to symptom overlap with many other diseases. Peripheral arthritis, dactylitis, enthesitis and axial arthritis are the 4 domains of musculoskeletal involvement in PsA and careful examination of each domain by a rheumatologist is the first step for a correct diagnosis. Other extra-musculoskeletal features such as the presence of uveitis, inflammatory bowel disease, nail psoriasis and elevated acute phase reactants aid in the diagnosis of PsA. Screening patients with skin psoriasis using validated questionnaires might help in early diagnosis especially when coupled with imaging.
银屑病关节炎（PsA）是一种慢性异质性炎症性肌肉骨骼疾病。其非特异性和常较隐匿的表现使得早期诊断和后续治疗具有挑战性。在缺乏诊断标准和生物标志物的情况下，诊断常常被延误，导致长期预后不佳。此外，由于与许多其他疾病的症状重叠，在银屑病患者出现关节炎的情况下，鉴别诊断的范围很广。外周关节炎、指（趾）炎、附着点炎和中轴关节炎是 PsA 中肌肉骨骼受累的 4 个领域，风湿病医生对每个领域的仔细检查是正确诊断的第一步。其他肌肉骨骼外特征，如存在虹膜炎、炎症性肠病、甲银屑病和急性期反应物升高，有助于诊断 PsA。使用经过验证的问卷对银屑病患者进行筛查可能有助于早期诊断，尤其是与影像学检查相结合时。
