Psoriatic arthritis (psoriasis arthritis) – assessment at Charlottenlund Privathospital

What is psoriatic arthritis?



Psoriatic arthritis is part of the spondyloarthritis family, along with axial spondyloarthritis and the arthritis that can accompany inflammatory bowel disease. According to the Danish Society for Rheumatology’s national treatment guidelines, the condition is characterised by inflammation in the peripheral joints, the axial skeleton—the spine and pelvic joints—and the entheses, where tendons and ligaments attach to bone. In most people, the skin condition appears first, but in some, arthritis develops before psoriasis, or psoriasis is only subtle and found on the scalp, navel, in the ear canals or on the nails.

The condition differs from rheumatoid arthritis in several ways: it often affects joints asymmetrically, can affect the end joints of the fingers, can cause even swelling of an entire finger or toe (dactylitis), and arthritis tests for rheumatoid factor and anti-CCP are usually negative. The disease can range from mild symptoms in a few joints to active disease in many joints, and treatment is tailored accordingly.

What are the symptoms of psoriatic arthritis?

Psoriatic arthritis can present in five ways, which may occur on their own or together. Swollen, tender joints—often just a few, and asymmetrically, such as one knee, one ankle or a few finger joints. Dactylitis, where an entire finger or toe swells like a sausage. Enthesitis, inflammation where tendons attach to bone, typically causing pain in the heel or sole of the foot. Inflammatory back pain that is worse at night and improves with movement. And nail changes—small pits, separation of the nail from the nail bed or yellowish spots—which are often associated with arthritis in the nearby finger joints.

Fatigue and morning stiffness are also common. Skin symptoms may be severe or almost invisible, and the extent of psoriasis does not correspond to how active the arthritis is. Uveitis, which causes a red, painful eye and sensitivity to light, can also occur and should be assessed by an ophthalmologist the same day.

What causes psoriatic arthritis?

The cause is not fully understood. The condition develops through an interaction between genetic predisposition and the immune system. In psoriasis, this causes inflammation in the skin; in psoriatic arthritis, it also affects the joints, tendons and spine. Psoriasis and psoriatic arthritis are more common in the same families. Excess weight and smoking worsen the course of the disease. Psoriatic arthritis is not contagious and is not caused by overuse or wear and tear.

How is psoriatic arthritis assessed?

Assessment begins with the medical history: joint pain, swelling, morning stiffness, heel pain, back pain, known psoriasis in the patient or their family, and eye symptoms. The clinical examination covers all joints, tendon insertions, the spine and pelvis, as well as the skin and nails—including the scalp, navel, ear canals and skin folds, where psoriasis can easily go unnoticed. Treatment guidelines recommend ultrasound scans when enthesitis, dactylitis or joint inflammation is suspected, and the consultant performs the scan during the initial consultation.

Blood tests include inflammatory markers and arthritis tests; negative arthritis tests in a patient with swollen joints and psoriasis support the diagnosis. Diagnosis is based on the overall picture using the international CASPAR criteria, which take into account psoriasis in the patient or their family, nail changes, dactylitis, a negative rheumatoid factor and characteristic bone changes. If further imaging of the spine or joints is needed, the consultant will refer the patient. If there is any doubt about the skin symptoms, the hospital’s consultant dermatologists are involved.

How is psoriatic arthritis treated?

Treatment depends on which parts of the disease are active. For a small number of swollen joints or enthesitis, anti-inflammatory arthritis medication and ultrasound-guided injections may be sufficient. For inflammation in several joints, treatment guidelines recommend disease-modifying arthritis medication, which may also benefit the skin. For spinal involvement, exercise and anti-inflammatory arthritis medication are the mainstays, as with axial spondyloarthritis. If disease activity remains high, the next step is biologic medication, which under current Danish regulations is given in a hospital setting.

At Charlottenlund Privathospital, the hospital’s dermatologists carry out the assessment and diagnosis of joint symptoms and treat the skin. If psoriatic arthritis is confirmed, patients are referred for disease-modifying treatment in a hospital setting with their completed assessment. While waiting, inflammation can be reduced with a corticosteroid injection. If the assessment indicates a need for biologic treatment, patients are referred on with their completed assessment so care can continue without delay.

When should I see a rheumatologist?

A rheumatology assessment is appropriate for people with psoriasis—or a family history of psoriasis—who develop swollen joints, a sausage-shaped swollen finger or toe, persistent heel pain, back pain that is worse at night, or nail changes alongside joint symptoms. It is also relevant when a GP or dermatologist has identified joint symptoms in someone with psoriasis, or when joint pain is not consistent with osteoarthritis or overuse. Early assessment matters because untreated inflammation can cause permanent joint damage.

Assessment at Charlottenlund Private Hospital

Assessment and treatment are provided by consultant rheumatologists on an outpatient basis. The initial consultation typically takes 20–30 minutes; blood tests and an ultrasound scan can often be done the same day. If the diagnosis is confirmed, a referral is sent with the completed assessment, and the patient is followed up by the consultant. The skin condition is treated by the hospital’s consultant dermatologists.

Most patients come via health insurance; insurers typically require a referral from a GP and pre-authorisation before an appointment can be booked. Self-paying patients do not need a referral, and prices are listed on the price list. Appointments can be booked online 24/7 or by calling 44 98 19 21 Monday to Friday, 08:00–14:00. Outside phone hours, the digital telephone assistant Anna can book, cancel and reschedule appointments. [Button: Book online → /online-booking]