Clinical screening of psoriatic arthritis.

Aim Because of doubts in early clinical assessment and full documentation o f all various cases of psoriatic arthritis outside of rheumatologic centres a clinical study in a dermatologic department of a rehabilitation clinic w as performed. Methods: 148 patients between 1996 and 1999 were interviewed and examined clinically. 27 (18.2%) of them had osseous joint processes pro ved by X-ray (severe cases). 90 (60.8%) patients had no radiologic changes but a positive history of joint pain (mild cases). 31 (21%) patients had no ne of the problems (Control group). Blood specimens were taken in order to reveal inflammations (ESR. CRP, RF, ASL, uric acid, and leucocytes). Exclus ion criteria were other arthritides, multiple osteoarthritis and consolidat ed fractures of joints. The groups were compared together. Results: Whereas palpable joint crepitations did not turn out as a reliable specific sign, pressure pain on acromioclavicular joints and MTP joints, impingement signs of the shoulders, deformities of toes and flexor tendon swellings of the h and were usable tools in diagnosing a severe psoriatic arthritis in this st udy. The ESR, ASL, CRP, and uric acid were elevated significantly more ofte n in severe than in mild cases. Moreover, the time period between the first onset of skin lesions and joint pain was shorter in severe cases than in m ild cases (9.86 vs 13.8 years). Conclusion: The diagnostic relevance of cri teria, for example of the well-known European Spondylarthropathy Group (ESS G), may be improved by new early screening criteria.