Screenings if you have psoriasis

Joint checks for psoriatic arthritis

NICE says to offer an annual assessment for psoriatic arthritis to people with any type of psoriasis, and that the assessment is especially important within the first 10 years of onset of psoriasis. It says to use a validated tool to assess adults in primary care and specialist settings, for example the Psoriasis Epidemiological Screening Tool (PEST), and to be aware that the PEST does not detect axial arthritis or inflammatory back pain. As soon as psoriatic arthritis is suspected, NICE says to refer the person to a rheumatologist. (NICE CG153) A 2017 review in the Journal of the American Academy of Dermatology says all patients with psoriasis should be asked whether they have joint symptoms, including joint swelling, tenderness, and morning stiffness that lasts for at least 30 minutes and improves with activity. (Takeshita, 2017)

The NHS lists these symptoms of psoriatic arthritis: (NHS, psoriatic arthritis)

pain, swelling and stiffness in 1 or more joints
swollen fingers or toes
nails changing from their usual colour, or tiny dents or pits developing in the nails
feeling drained of energy

The NHS says psoriatic arthritis can sometimes develop after someone has had psoriasis for many years. (NHS, psoriatic arthritis) See screenings if you have rheumatoid arthritis or lupus.

Heart risk, blood pressure and cholesterol

MedlinePlus says people with psoriasis have an increased risk for fatty liver disease and cardiovascular disorders, such as heart disease and stroke. (MedlinePlus) NICE says: (NICE CG153)

offer adults with severe psoriasis of any type (defined in NICE's studies as needing phototherapy or systemic treatment, or needing hospital admission) a cardiovascular risk assessment at presentation using a validated risk estimation tool
offer further assessment of cardiovascular risk every 5 years, or more often if indicated following assessment
discuss risk factors for heart and blood vessel conditions with people who have any type of psoriasis, and their families or carers where appropriate

The 2017 review says patients with psoriasis are underscreened for heart risk factors, and that at a minimum they should be screened for these risk factors according to recommendations for the general adult population. It says patients with psoriasis should have at least the standard blood pressure screening, and lipid (cholesterol) screening at least per the standard recommendations, for the general population. (Takeshita, 2017) See heart screenings by age, blood pressure readings: what they mean and cholesterol test by age.

Blood sugar

The NHS lists metabolic syndrome, which can lead to conditions such as diabetes and cardiovascular disease, among the complications of psoriasis, and says people with psoriasis will have regular check-ups. (NHS) The 2017 review says that, as psoriasis is associated with an increased risk of diabetes, patients should be screened for diabetes at least per standard recommendations for the general population. (Takeshita, 2017) See A1C and blood sugar test results and screenings if you have diabetes.

Fatty liver

MedlinePlus says people with psoriasis have an increased risk for fatty liver disease. (MedlinePlus) The sources on this page do not set a liver screening schedule for people with psoriasis apart from checks tied to specific treatments. See fatty liver screening (FIB-4) and liver function test results.

Mood and wellbeing

NICE says to assess the impact of psoriasis on physical, psychological and social wellbeing by asking, among other things, whether the psoriasis has an impact on the person's mood or causes them distress, and to be aware that the person may have levels of distress and not be clinically depressed. NICE also says to assess whether people with any type of psoriasis are depressed when assessing disease severity and impact. (NICE CG153) The NHS says it is common for psoriasis to affect your mental health. (NHS) The 2017 review says screening for mood disorders should be considered, particularly with more severe disease, and that clinicians should consider screening for depression and suicidality. (Takeshita, 2017) See depression screening: what to expect and mental health screenings by age.

HIV testing

NICE notes that severe or atypical psoriasis is an HIV indicator condition, and points to its guideline on HIV testing. (NICE CG153) See HIV test results.

Usual cancer and skin screening

Psoriasis does not change the general cancer screening schedules in the sources on this page. The 2017 review says patients with psoriasis on immunosuppressive therapy should follow guidelines for age-appropriate cancer screening, and that annual skin cancer screening may be considered in people with psoriasis receiving immunosuppressive medicines or phototherapy (level of evidence III to IV). (Takeshita, 2017) See cancer screenings by age, skin checks by age and skin cancer check: what to expect.

When to contact a provider

MedlinePlus, psoriasis, when to contact a medical professional: (MedlinePlus)

Contact your provider if you have symptoms of psoriasis or if your skin irritation continues despite treatment.
Tell your provider if you have joint pain or fever with your psoriasis attacks.
If you have symptoms of arthritis, talk to your provider, dermatologist or rheumatologist.
Go to the emergency room or call 911 or the local emergency number if you have a severe outbreak that covers all or most of your body.

The NHS says to see a GP if you have psoriasis and also have pain, stiffness and swelling in your joints that keeps coming back, and to call 999 or go to A&E if your skin quickly turns red and you develop white, pus-filled bumps that join together. (NHS)

Where they differ:

Heart risk checks. NICE ties a formal cardiovascular risk assessment, at presentation and every 5 years, to adults with severe psoriasis, and asks for a talk about heart risk factors with everyone with psoriasis; (NICE CG153) the 2017 review says everyone with psoriasis should, at a minimum, get the heart risk factor screening recommended for the general adult population, and asks whether psoriasis alone should mean more screening. (Takeshita, 2017)
Depression. NICE says to assess for depression in everyone with psoriasis as part of assessing severity and impact; (NICE CG153) the 2017 review says screening should be considered, particularly with more severe disease, and sets no interval. (Takeshita, 2017)

Your doctor decides what your result means for you.

Questions people ask

How often should someone with psoriasis be checked for psoriatic arthritis?

NICE says to offer an annual assessment for psoriatic arthritis to people with any type of psoriasis, and that this is especially important within the first 10 years of onset. It suggests a validated tool such as the Psoriasis Epidemiological Screening Tool (PEST) for adults. (NICE CG153)

Does psoriasis mean more heart checks?

NICE says to offer adults with severe psoriasis a cardiovascular risk assessment at presentation and again every 5 years, or more often if indicated. A 2017 review in the Journal of the American Academy of Dermatology says people with psoriasis should, at a minimum, be screened for heart risk factors as the general adult population is. (NICE CG153) (Takeshita, 2017)

Should people with psoriasis be screened for depression?

NICE says to assess whether people with any type of psoriasis are depressed when assessing how severe the psoriasis is and the impact it has. The 2017 review says screening for mood disorders should be considered, particularly with more severe psoriasis. (NICE CG153) (Takeshita, 2017)

Does psoriasis change the usual cancer screening schedule?

The sources on this page do not set a different schedule. The 2017 review says people with psoriasis on immunosuppressive therapy should follow age-appropriate cancer screening, and that annual skin cancer screening may be considered for people receiving immunosuppressive medicines or phototherapy. (Takeshita, 2017)