Adults
Psoriatic arthritis (suspected)
Joint swelling, dactylitis or enthesitis with current or past psoriasis, or a family history of psoriasis.
What to look for
- Psoriasis now or in the past. Check the scalp, ears, umbilicus, gluteal cleft and nails (pitting, onycholysis).
- Patterns: asymmetric oligoarthritis, symmetric polyarthritis, DIP-predominant disease, axial disease, or arthritis mutilans
- Dactylitis ("sausage digit") and enthesitis (Achilles, plantar fascia)
- Uveitis or inflammatory bowel disease may coexist
What to do
- Refer within 2–4 weeks. Early treatment prevents irreversible joint damage.
- Send ESR, CRP, RF and anti-CCP (usually negative in PsA, which helps separate it from RA), CBC and a metabolic panel.
- Get X-rays of affected hands and feet.
- ESR and CRP are often normal in PsA, so normal results should not delay referral.
Good to know
- New treatment options keep arriving. Deucravacitinib (a TYK2 inhibitor) was FDA-approved for PsA in March 2026.
About this urgency level
Early specialist assessment changes outcomes. Send the usual workup with the referral, but don't hold the referral while waiting for results.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.