Referral criteria for suspected psoriatic arthritis and other peripheral spondyloarthritides

Referral for suspected psoriatic arthritis and other peripheral spondyloarthritides

For guidance on identifying spondyloarthritis in people with an existing diagnosis of psoriasis, see assessment and referral for psoriatic arthritis in the NICE guideline on psoriasis (1).

Assessment and referral for psoriatic arthritis (1)

• offer annual assessment for psoriatic arthritis to people with any type of psoriasis. Assessment is especially important within the first 10 years of onset of psoriasis
• use a validated tool to assess adults for psoriatic arthritis in primary care and specialist settings, for example the Psoriasis Epidemiological Screening Tool (PEST) -be aware that the PEST does not detect axial arthritis or inflammatory back pain.
• as soon as psoriatic arthritis is suspected, refer the person to a rheumatologist for assessment and advice about planning their care. Also see the NICE guideline on spondyloarthritis in over 16s

Urgently refer people with suspected new-onset inflammatory arthritis to a rheumatologist for a spondyloarthritis assessment, unless rheumatoid arthritis, gout or acute calcium pyrophosphate (CPP) arthritis ('pseudogout') is suspected. If rheumatoid arthritis is suspected, see referral for specialist treatment in the NICE guideline on rheumatoid arthritis in adults (2)

Refer people with dactylitis to a rheumatologist for a spondyloarthritis assessment.

Refer people with enthesitis without apparent mechanical cause to a rheumatologist for a spondyloarthritis assessment if:

• it is persistent or
• it is in multiple sites or
• any of the following are also present:
  • back pain without apparent mechanical cause
  • current or past uveitis
  • current or past psoriasis
  • gastrointestinal or genitourinary infection
  • inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • a first-degree relative with spondyloarthritis or psoriasis.

Reference:

• NICE (2012).Psoriasis: assessment and management.
• NICE (2017). Spondyloarthritis in over 16s: diagnosis and management