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Diagnosing Psoriatic Arthritis in the Dermatology Clinic

At the 2020 Winter Clinical Dermatology Conference, Drs Merola and Gottlieb spoke about their innovative sleeve for the diagnosis of psoriatic arthritis in the dermatology clinic.

Merola: We think the most important aspects of psoriatic arthritis that’s likely to show up in the dermatologist’s office, for example, is enthesitis and soft tissue involvement. How do we teach dermatologists, in addition to the history taking, to do the exam, and maybe even eventually think about aids in the clinic that might help with that exam? To that end, we codeveloped this lovely sleeve. There’s one for the upper extremity and the lower extremity. There’s some markings on the sleeve that help orient the anatomy and the points that a dermatologist really wants to focus on during an exam. So to begin with, sort of, the utility in the clinic and in terms of clinical education, the potential in the clinic through clinical trials and through, you know, other places where this might be important. So, you can see for example, key places like the epicondyle where enthesitis might happen, the yellow dots; the orange lines where the true elbow joint might be swollen and tender; areas that really would not have joints or tendon insertions that might represent fibromyalgia or soft tissue pain to help with differential diagnosis; the wrist line; the MCPs, and the other small joints that could be involved. So, really, [this sleeve is] an aid to teach people where things are.Similarly, we have a dot here for the base of the thumb, which is most classically osteoarthritis and not inflammatory arthritis. That might make someone think of osteo and not inflammatory that would maybe redirect the treatment or the referrals.

Gottlieb: I’m hoping that in the future that we will make these disposable, like when ladies go try on shoes and there’s this box of peds there that are disposable, because they have to be different from one patient to the other. We also are going to add to this; we’re going to add a sock because the Achilles tendon tendinitis is actually the most specific for psoriatic arthritis. And also the sock will point out plantar fasciitis in the actual ankle joint arthritis, and that’s coming up. And as I said we’d like to make it disposable so whether it’s the MD or whether it’s the medical assistant or resident can do that and be extremely helpful.

Merola: So we just like to think that dermatologists should own, the same way we’re comfortable with skin exams, really own the psoriatic arthritis screening all the way down to a basic physical exam, which they are absolutely capable of learning and doing.

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