Psoriatic Arthritis - Diagnosis and Treatment

The diagnosis of psoriatic arthritis is often based on a combination of clinical assessment, physical examination findings, and diagnostic tests, which help the rheumatologist confirm the condition. Since there is no single test that can definitively diagnose psoriatic arthritis, a thorough evaluation is essential to distinguish it from other types of arthritis, such as rheumatoid arthritis or osteoarthritis.

To determine the appropriate diagnostic approach, the rheumatologist takes into account the following factors before selecting the tests to diagnose psoriatic arthritis:

• Clinical assessment and patient history
• Physical examination

Clinical assessment and patient history

Clinical assessment and patient history play a crucial role in diagnosing psoriatic arthritis, as they help identify characteristic patterns of joint, skin, and nail involvement. 

• A complete medical history starts with documenting the onset, pattern, and progression of joint symptoms, including pain, swelling, tenderness, stiffness (especially in the morning), and any axial or peripheral joint involvement. 
• The presence of dactylitis, which causes sausage-like inflammation of fingers or toes, enthesitis, an inflammation at tendon or ligament attachment sites, and spinal involvement, is a key indicator that support the diagnosis.
• A detailed patient history helps determine the presence or family history of psoriasis, the onset and duration of joint pain, stiffness (particularly morning stiffness), and any factors that worsen or relieve symptoms. 
• Additionally, information about past skin or nail changes, such as scaly patches, pitting, or thickening, provides valuable diagnostic clues. 
• Together, clinical assessment and medical history help the doctor distinguish psoriatic arthritis from other inflammatory arthritic conditions and establish an early, accurate diagnosis.

Physical examination



Physical examination plays an essential role in the diagnosis of psoriatic arthritis (PsA) because it provides direct evidence of inflammation and characteristic physical findings that help distinguish PsA from other joint disorders. 

• During the physical assessment, the rheumatologist carefully examines multiple body regions, including joints, skin, nails, tendons, and the spine, to identify both musculoskeletal and dermatologic features associated with the disease.
• Joint examination in psoriatic arthritis (PsA) looks for tenderness, swelling, warmth, and reduced range of motion, indicating synovial inflammation. PsA generally shows asymmetric joint involvement, affecting both small and large joints. 
• A key clinical feature of psoriatic arthritis is dactylitis (“sausage digits”), caused by inflammation of the entire finger or toe. Gentle squeezing of affected digits can reveal diffuse tenderness, a strong clinical clue for PsA.
• Another important exam finding in PsA is enthesitis (inflammation at tendon or ligament insertion sites). Common sites include the Achilles tendon, plantar fascia, and lateral elbow. Localised tenderness on palpation helps identify enthesitis and can distinguish PsA from rheumatoid arthritis.
• Skin and nail examination is key in PsA diagnosis. Psoriatic lesions appear as red, scaly patches on the scalp, elbows, knees, or behind the ears. Nail changes like pitting, thickening, discolouration, and onycholysis further support the diagnosis.
• The spine and sacroiliac joints are checked for tenderness or stiffness, especially with back pain. Reduced mobility or sacroiliac tenderness may suggest axial psoriatic arthritis, affecting the spine and pelvis.
  

Psoriatic Arthritis Diagnostic Tests

Based on the above findings, a rheumatologist may advise diagnostic tests to confirm psoriatic arthritis and evaluate the extent of joint, tendon, and spine involvement, as well as rule out other similar conditions like rheumatoid arthritis or gout.

The following tests might be recommended to diagnose PsA and assess related complications:

• Laboratory tests
• Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies
• Inflammatory markers (ESR AND CRP)
• Synovial fluid analysis
• Uric acid levels
• Antinuclear antibodies (ANA)
• Genetic testing 
• Imaging test
• Plain X-rays
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Musculoskeletal ultrasound (MSUS)
• CASPAR criteria for psoriatic arthritis 
  

Laboratory tests

Laboratory investigations play an important supportive role in diagnosing psoriatic arthritis. Lab tests are essential to rule out other forms of arthritis and to assess the degree of inflammation in the body. The following laboratory tests are commonly used in the diagnostic workup of psoriatic arthritis:

Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) antibodies

• These tests are primarily utilised to differentiate psoriatic arthritis (PsA) from rheumatoid arthritis (RA). In PsA, RF and anti-cyclic citrullinated peptide (anti-CCP) antibodies are usually negative, whereas these markers are often positive in RA. 
• However, a small percentage of PsA patients may show low levels of RF. Therefore, the absence of these antibodies supports the diagnosis of psoriatic arthritis, especially when joint inflammation is accompanied by psoriasis.

Inflammatory markers (ESR and CRP)

• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are blood tests that assess the degree of inflammation in the body. In PsA, these markers are generally elevated, indicating active joint or systemic inflammation.
• While they are not specific to PsA, persistently raised ESR or CRP values indicate disease activity, helping the doctor to monitor inflammation and treatment response over time.

Synovial fluid analysis

• This involves aspirating joint fluid (arthrocentesis) from an inflamed joint to evaluate its characteristics. In PsA, the synovial fluid generally shows increased white blood cell counts (predominantly neutrophils), indicating inflammation but without infection. 
• This test helps exclude other causes of joint inflammation, such as septic arthritis or gout, where urate crystals would be visible under polarised microscopy. Thus, synovial fluid analysis helps confirm inflammatory arthritis consistent with PsA.

Uric acid levels

• Measuring serum uric acid levels helps differentiate psoriatic arthritis from gout, as both can cause joint pain and swelling. Elevated uric acid levels may sometimes be seen in PsA due to increased skin cell turnover from psoriasis, but the absence of urate crystals in synovial fluid helps rule out gout.
• Therefore, uric acid testing is a valuable adjunct in distinguishing PsA from other crystal-induced arthropathies.

Antinuclear antibodies (ANA)

ANA testing helps rule out autoimmune conditions like systemic lupus erythematosus (SLE), which can also present with joint pain and inflammation. In psoriatic arthritis, ANA is usually negative or low-titer positive without clinical significance. Hence, ANA testing aids in differentiating PsA from lupus and other connective tissue diseases that may mimic it.

Genetic testing 

• Genetic testing helps in diagnosing psoriatic arthritis by looking for certain genes that make a person more likely to develop the disease. The most common gene linked to PsA is HLA-B27, especially in those with spine involvement. Other genes like HLA-Cw6, HLA-B38, and HLA-DR7 are also associated with PsA. 
• Finding these genes does not confirm the disease on its own, but it supports the diagnosis when combined with symptoms, family history, and other test results. This helps doctors better understand a person’s risk, disease pattern, and possible response to treatment.

Imaging test

Plain X-rays

• Plain radiographs are the first-line imaging tool for suspected psoriatic arthritis (PsA), primarily useful for detecting established structural changes rather than early inflammation. They can reveal a characteristic combination of marginal erosions and new bone formation (osteoproliferation), fluffy periostitis, “pencil-in-cup” deformities, ankylosis, acro-osteolysis, asymmetric sacroiliitis, and coarse syndesmophytes. 
• These features help differentiate PsA from rheumatoid arthritis and osteoarthritis. X-rays are useful for monitoring the course of the disease and establishing baselines, but they are not very effective at identifying PsA in its early stages.

Computed tomography (CT) scan

• CT scans generate comprehensive cross-sectional images of bones and joints. They aid in the identification of small erosions and new bone growths that may not be seen on X-rays.
• CT scans are especially useful in assessing spinal and sacroiliac joint involvement, where PsA can cause inflammation and fusion (ankylosis).

Magnetic resonance imaging (MRI) 

• MRI is the most sensitive method for detecting early and active inflammation in PsA. It visualises bone marrow edema, synovitis (inflammation of the joint lining), enthesitis, tenosynovitis, and structural changes such as erosions, fat metaplasia, and ankylosis. Contrast enhances the detection of active synovitis and tendon sheath inflammation. 
• In axial PsA, MRI can reveal asymmetric sacroiliitis, discovertebral inflammation, and bulky syndesmophytes, often before X-ray changes appear. MRI is valuable for early diagnosis, distinguishing PsA from mimics (e.g., RA), and monitoring response to therapy, though its cost and limited availability may restrict routine use.

Musculoskeletal ultrasound (MSUS)

Ultrasound is an imaging technique that helps detect joint effusion, synovial thickening, and tendon inflammation. It can visualise enthesitis, one of the key features of PsA, and is useful for guiding joint or tendon injections. MSUS is also helpful for early detection and disease monitoring, making it a practical tool in clinical settings.

CASPAR criteria for psoriatic arthritis

• CASPAR (classification criteria for psoriatic arthritis) criteria are widely used by doctors to help diagnose psoriatic arthritis (PsA) accurately. These criteria are based on a set of clinical, laboratory, and radiographic characteristics that distinguish PsA from other kinds of arthritis. 
• To apply the CASPAR criteria, the patient must first have evidence of inflammatory articular disease, which can include joint, spine, or enthesis inflammation. Once this is established, points are given for specific features:
• Current psoriasis (2 points) – The presence of active skin psoriasis.
• Personal or family history of psoriasis (1 point) – If psoriasis is not currently present but has occurred in the past or in a first- or second-degree relative.
• Psoriatic nail changes (1 point) – Such as pitting, onycholysis (nail lifting), or thickening.
• Negative rheumatoid factor (1 point) – Helps differentiate PsA from rheumatoid arthritis.
• Dactylitis (1 point) – Current or past swelling of an entire finger or toe (“sausage digit”).
• Radiologic evidence of new bone formation (1 point) – On imaging, showing new bone growth near joints (excluding osteophytes).

A total score of 3 or more points confirms a diagnosis of psoriatic arthritis according to the CASPAR criteria.

Stages of Psoriatic Arthritis

The stages of psoriatic arthritis describe the progression and severity of the disease, helping rheumatologists to assess joint damage, functional impact, and treatment needs. Classifying the disease into stages helps evaluate disease activity, guide therapy choices, and monitor the response to treatment. They include the following: 

Preclinical stages (before clinical arthritis)

These three clinically silent (quiet) phases occur after psoriasis begins, but before psoriatic arthritis (PsA) becomes clinically detectable. These phases are:

• Preclinical phase: In this stage, the immune system becomes abnormally activated, possibly starting in the skin, gut, or entheses, but no joint symptoms are yet visible.
• Subclinical PsA phase: This phase shows biomarker and imaging evidence of early inflammation, but no clinical joint symptoms are present.
• Prodromal PsA phase: In this stage, patients have arthralgia (joint pain) and fatigue without clinical synovitis or enthesitis, though imaging may reveal early tenosynovitis (inflammation of the tendon sheath).

Clinical psoriatic arthritis stages

Once arthritis becomes clinically apparent (diagnosable PsA), the disease severity is classified into mild, moderate, or severe stages based on joint involvement, symptoms, function, and skin disease:

• Mild psoriatic arthritis: In the mild stage of psoriatic arthritis (PsA), fewer than five joints are affected without any X-ray damage or loss of function. The disease has little impact on quality of life, and patients often describe symptoms as mild. Skin involvement is limited (<5% body surface area (BSA), psoriatic area severity index (PASI) <5), and most respond well to topical therapy. Spinal symptoms are less, and enthesitis or dactylitis, if present, are mild and do not impair normal activity.
• Moderate psoriatic arthritis: In moderate psoriatic arthritis, more than five joints are affected, often with early X-ray changes and moderate loss of function. Symptoms have a noticeable impact on daily life, and patients usually rate disease severity as moderate. Skin lesions may not respond well to topical therapy (PASI <10, DLQI <10). Spinal involvement can impair movement (BASDAI >4), while enthesitis affects multiple sites, and dactylitis may cause mild functional loss or erosive changes. Treatment typically includes NSAIDs or conventional DMARDs.
• Severe psoriatic arthritis: In severe psoriatic arthritis, more than five joints are affected with marked structural damage on imaging. Patients have poor treatment response, significant loss of function, and a major decline in quality of life. Skin disease is extensive (BSA >10%, PASI >10, DLQI >10). Spinal inflammation is often treatment-resistant with severe functional impairment, while enthesitis and dactylitis are widespread, persistent, and disabling.
  

Psoriatic arthritis (PsA) can be difficult to distinguish from other conditions because many share similar symptoms like joint pain, swelling, and stiffness. Accurate diagnosis is important to guide effective treatment. Rheumatologists use clinical evaluation, laboratory tests, and imaging to differentiate PsA from other diseases.

The main diseases commonly considered in the differential diagnosis of PsA are:

Gout and pseudogout: These conditions are caused by the deposition of crystals in joints, uric acid crystals in gout and calcium pyrophosphate crystals in pseudogout. They can mimic PsA with sudden joint swelling and pain, but unlike PsA, crystal analysis of synovial fluid confirms the diagnosis.

Osteoarthritis (OA): OA is a degenerative joint disease caused by "wear and tear" rather than inflammation. It primarily affects weight-bearing joints like knees and hips, but lacks significant soft tissue swelling or systemic inflammation seen in PsA. 

Reactive arthritis: This inflammatory arthritis develops after infections elsewhere in the body, often in the urinary or gastrointestinal tracts. It can mimic PsA with joint pain and skin lesions, but generally follows a known infection and may involve inflammation of the eyes and urinary tract.

Rheumatoid arthritis (RA): It is an autoimmune disease that also causes chronic joint inflammation, but differs from PsA in pattern and lab findings. RA usually causes symmetric joint involvement, particularly in the small joints of the hands, and is often positive for rheumatoid factor (RF) or anti-CCP antibodies.

Septic arthritis: It is a joint infection caused by bacteria, leading to severe pain, redness, and swelling. While PsA involves immune-driven inflammation, septic arthritis involves actual infection within the joint space and requires urgent treatment with antibiotics or drainage.

Considerations of a rheumatologist for treating psoriatic arthritis

Psoriatic Arthritis Treatment Goals

The main goals for treating psoriatic arthritis are:

• To control symptoms: The primary aim is to reduce joint pain, stiffness, swelling, and fatigue to improve patient comfort and mobility in daily life.
• To prevent structural joint damage: Early and effective treatment helps stop inflammation from causing irreversible bone and joint destruction, preventing deformities and disability.
• To normalise function: Restoring joint movement and physical ability allows patients to perform daily tasks, maintain independence, and stay active.
• To maximise quality of life: By relieving symptoms, protecting joints, and maintaining function, treatment enhances overall well-being, emotional health, and social participation.

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The treatment of psoriatic arthritis (PsA) is individualised based on disease domains (e.g., peripheral joints, skin, entheses, spine), severity, comorbidities, and patient preferences. Psoriatic arthritis treatment options includes the following:

Non-pharmacological treatment for psoriatic arthritis

• Physical exercise
• Weight management
• Heat and cold therapy
• Physical and occupational therapy
• Smoking cessation

Pharmacological treatment for psoriatic arthritis

• For mild psoriatic arthritis
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Low-dose corticosteroids
• For mild to moderate psoriatic arthritis or when NSAIDS are insufficient:
• Conventional synthetic disease-modifying antirheumatic drug (csDMARDs)
• For moderate to severe psoriatic arthritis or when csDMARDs fail:
• Biologic DMARDs (bDMARDs)
• Tumor necrosis factor (TNF) inhibitors
• Interleukin (IL)-17 inhibitors
• IL-12/23 inhibitors
• T-cell co-stimulation modulator
• Targeted synthetic DMARDs (tsDMARDs)
• Janus kinase (JAK inhibitor)
• Phosphodiesterase-4 (PDE4) inhibitor

Surgical interventions

• Joint replacement surgery (arthroplasty)
• Synovectomy
• Joint fusion (arthrodesis)

Non-pharmacological treatment for psoriatic arthritis

Non-pharmacological treatments play a vital role in reducing symptoms, improving joint function, and quality of life. Combining all these strategies alongside medication can enhance treatment outcomes and quality of life.

These steps are:

Physical exercise

• Exercise helps to promote joint mobility, posture, muscle strength, and balance, thereby supporting the joints and relieving pain and weariness.
• Both low-impact activities showed reduced inflammation and improved functional status without worsening symptoms.
• Regular exercise also lowers cardiovascular risk and helps maintain bone health, which is crucial as PsA patients often have comorbidities.

Weight management

• Maintaining a healthy body mass index (BMI) reduces mechanical stress on joints, especially weight-bearing joints like knees and hips.
• Excess body weight is associated with higher disease activity and poorer response to some treatments.
• Weight loss by following a diet and exercise can decrease inflammation markers and improve overall outcomes.

Heat and cold therapy

• Applying heat helps relax muscles, improve circulation, and reduce stiffness.
• Cold therapy numbs painful areas, decreases inflammation, and reduces swelling.
• These therapies provide symptomatic relief and can be used adjunctively during flare-ups.

Physical and occupational therapy

• Physical therapy designs tailored exercise and mobility programs to maintain or restore joint function while avoiding injury.
• Occupational therapy provides strategies and assistive devices to help with daily activities, reducing joint strain and improving independence.

Smoking cessation

• Smoking increases disease severity, poorer treatment response, and higher cardiovascular risk in PsA.
• Quitting smoking reduces systemic inflammation and improves therapeutic outcomes.

Pharmacological treatment for psoriatic arthritis

Pharmacological therapy is main in managing psoriatic arthritis to reduce inflammation, control symptoms, prevent joint damage, and improve function and quality of life. The choice of medication is determined by the severity of the disease, the domains involved, and the patient's factors.

For mild psoriatic arthritis

• Non-steroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory medicines are the first-line medications used to treat pain, edema, and stiffness. They help reduce inflammation in the joints and increase mobility, but they do not protect against long-term joint damage. They are appropriate for people who have mild disease and no radiographic progression.

• Low-dose corticosteroids: Short-term or low-dose corticosteroids may be prescribed to control acute flares or inflammation. They provide quick relief by suppressing the immune response, but long-term use is avoided due to side effects and the risk of psoriasis flare on withdrawal.

For mild to moderate psoriatic arthritis

When nonsteroidal anti-inflammatory drugs (NSAIDs) are insufficient to control symptoms in mild to moderate PsA, csDMARDs are the next line of therapy. 

• Conventional synthetic DMARDs: These medications suppress the overactive immune system, reduce inflammation, and help prevent joint damage and deformity.

For moderate to severe psoriatic arthritis

Biologic DMARDs (bDMARDs) for moderate to severe psoriatic arthritis:  Biologic DMARDs are indicated for patients with moderate to severe PsA or those who have had an inadequate response to csDMARDs.

• TNF inhibitors: A major pro-inflammatory cytokine involved in systemic and joint inflammation, tumour necrosis factor-alpha, is blocked by these medications. They avoid structural damage and reduce skin and joint symptoms.

• Interleukin (IL)-17 inhibitors : This target IL-17, another major inflammatory molecule, effectively reduces joint pain, swelling, and psoriasis lesions.

• IL-12/23 inhibitors: Medications target IL-12 and IL-23 pathways, which help in reducing immune overactivity and improving both skin plaques and arthritis. 

• T-cell co-stimulation modulators: This drug inhibits T-cell activation by blocking co-stimulatory signals, reducing downstream inflammatory responses. These are used in selected cases with predominant joint involvement.

Targeted Synthetic DMARDs (tsDMARDs)

These are oral small-molecule drugs that block specific intracellular signalling pathways involved in inflammation.

• Janus kinase (JAK) inhibitors: These agents inhibit JAK enzymes, which are responsible for transmitting signals that trigger inflammation. They help control both joint and skin symptoms in moderate to severe PsA.
• Phosphodiesterase-4 (PDE4) inhibitor: PDE4 inhibitors work by increasing anti-inflammatory signals within cells, leading to reduced production of inflammatory cytokines. It is especially useful for patients with mild to moderate PsA who cannot tolerate or are unsuitable for biologic therapy.

Surgical interventions

These are considered when medical and non-surgical treatments fail to control inflammation, pain, or joint deformity. These procedures are: 

• Joint replacement surgery (arthroplasty): Joint replacement surgery also known as arthroplasty treats severe joint damage in psoriatic arthritis. It is especially common in weight-bearing joints like the hip and knee, and certain joints in the hand. The surgery replaces damaged joint surfaces with prosthetic parts. This helps relieve pain, restore alignment, and improve function. The outcomes are usually similar to those for osteoarthritis. However, the involvement of soft tissue in psoriatic arthritis may need careful planning during surgery. 

• Synovectomy: The surgical removal of the inflammatory synovial membrane lining the joint is known as a synovectomy. Prolonged synovial inflammation in PsA can cause joint erosion, pain, and swelling. Especially in smaller joints like the knees, wrists, or fingers, removing this tissue helps lower inflammation and prevent additional damage. Patients with persistent synovitis who have not responded to medication benefit from it the most.

• Joint fusion (arthrodesis): Joint fusion, or arthrodesis, is a surgery that joins two or more bones in a joint so they no longer move. This helps stabilise painful and damaged joints, especially in small joints like those in the hands, feet, and spine. While it stops joint movement, joint fusion reduces pain by preventing painful motion. It is used when joint replacement is not possible or when a joint needs extra stability.
  

The prognosis of psoriatic arthritis varies greatly between individuals and depends on the pattern of disease, severity, and therapy response. While some people have a mild type of PsA with little joint involvement and preserved function, others may have a more aggressive and severe course.

Patients with milder disease, limited joint involvement, and a good response to medications usually have a favourable prognosis. In contrast, those with polyarticular (many joints), axial (spine), or erosive PsA, as well as severe skin disease, enthesitis, or dactylitis, may experience a more chronic and progressive course.

The presence of comorbidities such as obesity, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease can worsen outcomes and reduce treatment effectiveness.

What is psoriatic arthritis?

Psoriatic arthritis is a long-term condition that causes inflammation in the joints and also affects the skin with a disease called psoriasis. It occurs when the body’s immune system mistakenly attacks its own joints and skin, causing pain, swelling, stiffness, and red, scaly skin patches. The symptoms may come and go, sometimes worsening during flare-ups, and PsA can affect any joint in the body.

What are the 5 types of psoriatic arthritis?

Psoriatic arthritis (PsA) presents in different patterns depending on which joints are affected. The five main types include:

• Oligoarticular PsA – Involves a small number of joints (typically fewer than five), often in an asymmetric pattern.
• Polyarticular PsA – Affects multiple joints, usually symmetrically, and can resemble rheumatoid arthritis in presentation.
• Distal interphalangeal (DIP)  predominant PsA – This targets the small joints at the ends of fingers and toes, often associated with nail changes.
• Spondylitis – This involves inflammation of the spine and sacroiliac joints, causing stiffness, pain, and reduced mobility in the back and neck.
• Arthritis mutilans – A rare and severe form marked by joint destruction, bone loss, and deformities, especially in the hands and feet.

How is psoriatic arthritis different from rheumatoid arthritis?

What is psoriatic arthritis mutilans?

Arthritis mutilans is a severe and rare form of psoriatic arthritis. It causes extreme joint damage, bone loss, and deformities, especially in the fingers and toes. The bones can erode so much that the joints collapse, leading to major loss of function. This form is painful and disabling, requiring early and aggressive treatment to try to prevent or limit progression.

What joints are affected by psoriatic arthritis?

Psoriatic arthritis can affect any joint in the body, including the small joints of the fingers and toes, wrists, knees, ankles, spine, and pelvis. It often involves the joints near the ends of the fingers (distal interphalangeal joints), and spine involvement (sacroiliac joints, vertebrae) is common in the “axial” subtype.

What triggers psoriatic arthritis?

Psoriatic arthritis can be triggered by a combination of genetic and environmental factors. Common triggers include infections, physical injury or trauma, stress, and sometimes certain medications. Obesity can also increase the risk by putting extra pressure on joints. The immune system reacts abnormally to these triggers, causing inflammation in the joints and skin.

What deficiency causes psoriatic arthritis?

There is no proven single nutrient deficiency that directly causes psoriatic arthritis. However, low vitamin D levels have been observed more often in people with PsA, and some researchers suggest vitamin D deficiency might contribute to worse disease outcomes.

Which bacteria cause psoriatic arthritis?

No single bacterium directly causes psoriatic arthritis, but some research shows that changes in the balance of gut bacteria may influence the immune system and increase the risk of psoriatic arthritis. Gut bacteria imbalances can raise inflammation levels and trigger immune responses.

What is psoriatic arthritis mistaken for?

Psoriatic arthritis is often mistaken for other joint diseases, especially rheumatoid arthritis (RA) and osteoarthritis (OA), because they share symptoms like joint pain, stiffness, and swelling. It may also be confused with gout or reactive arthritis when only a few joints are affected. The absence of specific blood markers and overlapping symptoms often delays accurate diagnosis, so imaging and clinical history are essential for differentiation.

Which is the best hospital for psoriatic arthritis Treatment in Hyderabad, India?

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