Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2005 Mar;64(Suppl 2):ii3–ii8. doi: 10.1136/ard.2004.032318

Classification and diagnostic criteria for psoriatic arthritis

P Helliwell, W Taylor
PMCID: PMC1766878  PMID: 15708931

Abstract

Background: The study of psoriatic arthritis is difficult and has lagged behind the study of other arthropathies in that there are no universally agreed or properly validated case definitions.

Method: This paper examined the validity and practicality of the original Moll and Wright criteria and subsequent criteria sets. Key features discriminating between psoriatic and other arthropathies were reviewed. A comparative study involving patients with psoriatic arthritis and rheumatoid arthritis was used to contrast the different classification methods.

Results: Although the Moll and Wright criteria continue to be widely used, they have been shown to discriminate poorly between psoriatic and rheumatoid arthritis. In comparison, the most sensitive criteria were those of Vasey and Espinoza, McGonagle et al, and Gladman et al (99%), whereas the others were significantly less sensitive (between 56% and 94%). The specificity of all methods was high and statistically similar (between 93% and 99%). Models that had reasonably good accuracy even without such key variables as psoriasis or rheumatoid factor were developed. Spinal involvement continues to be a key feature of psoriatic arthritis, but dissimilarities with classic ankylosing spondylitis have been highlighted.

Conclusions: Further work is required to produce classification criteria for psoriatic arthritis. A prospective study collecting clinical, radiological, human leucocyte antigen (HLA) and immunological data from both psoriatic and non-psoriatic cases should provide agreed criteria for use in psoriatic arthritis studies in the future.

Full Text

The Full Text of this article is available as a PDF (80.2 KB).

Figure 1.

Figure 1

Open in a new tab

 The proportion of patients in the asymmetrical oligoarthritis and symmetrical polyarthritis subgroups in several series of patients with psoriatic arthritis.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  2. BAKER H., GOLDING D. N., THOMPSON M. Psoriasis and arthritis. Ann Intern Med. 1963 Jun;58:909–925. doi: 10.7326/0003-4819-58-6-909. [DOI] [PubMed] [Google Scholar]
  3. BLUMBERG B. S., BUNIM J. J., CALKINS E., PIRANI C. L., ZVAIFLER N. J. ARA NOMENCLATURE AND CLASSIFICATION OF ARTHRITIS AND RHEUMATISM (TENTATIVE). Arthritis Rheum. 1964 Feb;7:93–97. doi: 10.1002/art.1780070113. [DOI] [PubMed] [Google Scholar]
  4. Battistone M. J., Manaster B. J., Reda D. J., Clegg D. O. The prevalence of sacroilitis in psoriatic arthritis: new perspectives from a large, multicenter cohort. A Department of Veterans Affairs Cooperative Study. Skeletal Radiol. 1999 Apr;28(4):196–201. doi: 10.1007/s002560050500. [DOI] [PubMed] [Google Scholar]
  5. Biondi Oriente C., Scarpa R., Pucino A., Oriente P. Psoriasis and psoriatic arthritis. Dermatological and rheumatological co-operative clinical report. Acta Derm Venereol Suppl (Stockh) 1989;146:69–71. [PubMed] [Google Scholar]
  6. Bizzaro N., Mazzanti G., Tonutti E., Villalta D., Tozzoli R. Diagnostic accuracy of the anti-citrulline antibody assay for rheumatoid arthritis. Clin Chem. 2001 Jun;47(6):1089–1093. [PubMed] [Google Scholar]
  7. Brewerton D. A., Hart F. D., Nicholls A., Caffrey M., James D. C., Sturrock R. D. Ankylosing spondylitis and HL-A 27. Lancet. 1973 Apr 28;1(7809):904–907. doi: 10.1016/s0140-6736(73)91360-3. [DOI] [PubMed] [Google Scholar]
  8. Dougados M., van der Linden S., Juhlin R., Huitfeldt B., Amor B., Calin A., Cats A., Dijkmans B., Olivieri I., Pasero G. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991 Oct;34(10):1218–1227. doi: 10.1002/art.1780341003. [DOI] [PubMed] [Google Scholar]
  9. Faraone S. V., Tsuang M. T. Measuring diagnostic accuracy in the absence of a "gold standard". Am J Psychiatry. 1994 May;151(5):650–657. doi: 10.1176/ajp.151.5.650. [DOI] [PubMed] [Google Scholar]
  10. Fournié B., Crognier L., Arnaud C., Zabraniecki L., Lascaux-Lefebvre V., Marc V., Ginesty E., Andrieu V., Dromer C., Fournié A. Proposed classification criteria of psoriatic arthritis. A preliminary study in 260 patients. Rev Rhum Engl Ed. 1999 Oct;66(10):446–456. [PubMed] [Google Scholar]
  11. Gladman D. D., Shuckett R., Russell M. L., Thorne J. C., Schachter R. K. Psoriatic arthritis (PSA)--an analysis of 220 patients. Q J Med. 1987 Feb;62(238):127–141. [PubMed] [Google Scholar]
  12. Gorter S., van der Heijde D. M. F. M., van der Linden S., Houben H., Rethans J. J., Scherpbier A. J. J. A., van der Vleuten C. P. M. Psoriatic arthritis: performance of rheumatologists in daily practice. Ann Rheum Dis. 2002 Mar;61(3):219–224. doi: 10.1136/ard.61.3.219. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Harrison B. J., Silman A. J., Barrett E. M., Scott D. G., Symmons D. P. Presence of psoriasis does not influence the presentation or short-term outcome of patients with early inflammatory polyarthritis. J Rheumatol. 1997 Sep;24(9):1744–1749. [PubMed] [Google Scholar]
  14. Helliwell P. S., Hetthen J., Sokoll K., Green M., Marchesoni A., Lubrano E., Veale D., Emery P. Joint symmetry in early and late rheumatoid and psoriatic arthritis: comparison with a mathematical model. Arthritis Rheum. 2000 Apr;43(4):865–871. doi: 10.1002/1529-0131(200004)43:4<865::AID-ANR18>3.0.CO;2-W. [DOI] [PubMed] [Google Scholar]
  15. Helliwell P. S., Hickling P., Wright V. Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis? Ann Rheum Dis. 1998 Mar;57(3):135–140. doi: 10.1136/ard.57.3.135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Helliwell P., Marchesoni A., Peters M., Barker M., Wright V. A re-evaluation of the osteoarticular manifestations of psoriasis. Br J Rheumatol. 1991 Oct;30(5):339–345. doi: 10.1093/rheumatology/30.5.339. [DOI] [PubMed] [Google Scholar]
  17. Jones S. M., Armas J. B., Cohen M. G., Lovell C. R., Evison G., McHugh N. J. Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease. Br J Rheumatol. 1994 Sep;33(9):834–839. doi: 10.1093/rheumatology/33.9.834. [DOI] [PubMed] [Google Scholar]
  18. Jónsson T., Thorsteinsson J., Kolbeinsson A., Jónasdóttir E., Sigfússon N., Valdimarsson H. Population study of the importance of rheumatoid factor isotypes in adults. Ann Rheum Dis. 1992 Jul;51(7):863–868. doi: 10.1136/ard.51.7.863. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. McEwen C., DiTata D., Lingg C., Porini A., Good A., Rankin T. Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. A comparative study. Arthritis Rheum. 1971 May-Jun;14(3):291–318. doi: 10.1002/art.1780140302. [DOI] [PubMed] [Google Scholar]
  20. McGonagle D., Conaghan P. G., Emery P. Psoriatic arthritis: a unified concept twenty years on. Arthritis Rheum. 1999 Jun;42(6):1080–1086. doi: 10.1002/1529-0131(199906)42:6<1080::AID-ANR2>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]
  21. Moll J. M., Wright V. Familial occurrence of psoriatic arthritis. Ann Rheum Dis. 1973 May;32(3):181–201. doi: 10.1136/ard.32.3.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Moll J. M., Wright V. Psoriatic arthritis. Semin Arthritis Rheum. 1973;3(1):55–78. doi: 10.1016/0049-0172(73)90035-8. [DOI] [PubMed] [Google Scholar]
  23. O'Neill T., Silman A. J. Psoriatic arthritis. Historical background and epidemiology. Baillieres Clin Rheumatol. 1994 May;8(2):245–261. doi: 10.1016/s0950-3579(94)80017-0. [DOI] [PubMed] [Google Scholar]
  24. Palazzi C., Olivieri I., Petricca A., Salvarani C. Rheumatoid arthritis or psoriatic symmetric polyarthritis? A difficult differential diagnosis. Clin Exp Rheumatol. 2002 Jan-Feb;20(1):3–4. [PubMed] [Google Scholar]
  25. Plunkett A., Marks R. A review of the epidemiology of psoriasis vulgaris in the community. Australas J Dermatol. 1998 Nov;39(4):225–232. doi: 10.1111/j.1440-0960.1998.tb01478.x. [DOI] [PubMed] [Google Scholar]
  26. Taylor W. J., Fellow D. E., Helliwell P. S. Case definition of psoriatic arthritis. Lancet. 2000 Dec 16;356(9247):2095–2096. doi: 10.1016/S0140-6736(00)03417-6. [DOI] [PubMed] [Google Scholar]
  27. Torre Alonso J. C., Rodriguez Perez A., Arribas Castrillo J. M., Ballina Garcia J., Riestra Noriega J. L., Lopez Larrea C. Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients. Br J Rheumatol. 1991 Aug;30(4):245–250. doi: 10.1093/rheumatology/30.4.245. [DOI] [PubMed] [Google Scholar]
  28. Veale D. J. The epidemiology of psoriatic arthritis: fact or fiction? J Rheumatol. 2000 May;27(5):1105–1106. [PubMed] [Google Scholar]
  29. Veale D., Rogers S., Fitzgerald O. Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol. 1994 Feb;33(2):133–138. doi: 10.1093/rheumatology/33.2.133. [DOI] [PubMed] [Google Scholar]
  30. WRIGHT V. Psoriasis and arthritis. Ann Rheum Dis. 1956 Dec;15(4):348–356. doi: 10.1136/ard.15.4.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. WRIGHT V. Psoriatic arthritis; a comparative study of rheumatoid arthritis, psoriasis, and arthritis associated with psoriasis. AMA Arch Derm. 1959 Jul;80(1):27–35. doi: 10.1001/archderm.1959.01560190029004. [DOI] [PubMed] [Google Scholar]
  32. WRIGHT V. Rheumatism and psoriasis: a re-evaluation. Am J Med. 1959 Sep;27:454–462. doi: 10.1016/0002-9343(59)90011-7. [DOI] [PubMed] [Google Scholar]
  33. Yang I., Becker M. P. Latent variable modeling of diagnostic accuracy. Biometrics. 1997 Sep;53(3):948–958. [PubMed] [Google Scholar]
  34. de Vlam K., Mielants H., Verstaete K. L., Veys E. M. The zygapophyseal joint determines morphology of the enthesophyte. J Rheumatol. 2000 Jul;27(7):1732–1739. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES