Table 1

Overarching principle and points to consider for the definition of clinical and imaging features suspicious for progression to PsA

2022 EULAR points to consider for the definition of clinical and imaging features suspicious for progression to PsA
Overarching principleLoELoA
A. People with PsO may develop PsA at different time-points.n.a.9.7 (± 0.7)
95.8% >8
B. Close collaboration between dermatologists and rheumatologists is important to understand and optimise PsA prevention, interception and early diagnosis.n.a.9.7 (± 0.6)
91.6% >8
C. The identification of risk factors for PsA development in people with PsO may influence therapy choices for PsO.n.a.8.9 (± 1.3)
75.0% >8
D. The rheumatologist has a key role in the diagnosis and management of PsA.n.a.9.7 (± 0.6)
91.6% >8
E. Certain systemic treatments of PsO may reduce the risk of transition to PsA.n.a.8.4 (± 1.8)
56.0% >8
Specific points to consider
1. Arthralgia in people with PsO should be considered as a risk factor for PsA development, taking into account alternative diagnoses such as osteoarthritis and fibromyalgia.3a9.2 (± 1.3)
75.0% >8
2. In people with PsO, joint and entheseal pain and functional limitation should be enquired about regularly and, if present, referral to a rheumatologist should be considered.3b9.3 (± 0.9)
83.3% >8
3. Imaging (including ultrasound and MRI) in people with PsO could be used to help identify those at risk for PsA; in particular to detect synovio-entheseal involvement/abnormalities.3b9.1 (± 1.2)
75.0% >8
4. Imaging abnormalities in the absence of musculoskeletal symptoms should be considered carefully in order to avoid the risk of inappropriate treatment.*3b9.5 (± 0.9)
83.3% >8
5. The combination of musculoskeletal symptoms and imaging abnormalities in people with PsO, without a diagnosis of PsA, should be considered as an entry criterion for clinical trials to prevent the transition to PsA.58.8 (± 1.2)
58.3% >8
6. In the context of clinical trials, people with PsO and clinically evident synovitis should be considered to have PsA, when alternative diagnoses have been excluded.59.3 (± 0.8)
83.3% >8
7. In people with PsO who require systemic treatment, the risk of transition to PsA should be taken into account in the choice of treatment.59.1 (± 1.3)
75.0% >8
8. People with PsO with obesity, nail disease and/or extensive PsO should be considered at increased risk for PsA development over the longer term.3a9.3 (± 0.9)
83.3% >8
9. People with PsO should be informed about the risk of developing PsA and prompted to report their symptoms to facilitate early PsA recognition.59.5 (± 0.8)
83.3% >8
10. In people with PsO, risk factors for PsA development should be regularly assessed over time.59.5 (± 0.8)
87.5% >8
  • *In the event that physicians incidentally perform musculoskeletal imaging (eg, ultrasound and MRI) in people with PsO without joint symptoms and the imaging is abnormal, then this in itself is not an impetus to consider therapy as such abnormalities are not uncommon in healthy individuals and consequently also PsO.30 31 49 The task force agreed that musculoskeletal imaging should be performed in people with PsO without joint symptoms only in research setting and not in clinical practice.

  • LoA, level of agreement; LoE, level of evidence; n.a., not available; PsA, psoriatic arthritis; PsO, psoriasis.