Cutting a lifted toe nail - yes or no?!

[Caroline]

Well in fact the diagnoses of PsA is very difficult. There is nothing in the blood that will point to PsA.
So the possibilities are:

• Being at least a very good rheumatologist.
  
• Having joint pains, often first in fingers and feet
  
• Having swollen joints
  
• Having enthesitis, inflammation of tendons near the attachment to the bones
  
• Doing a pet scan or MRI of the relevant joint. 
  
• Excluding rheuma by checking the blood on rheum factors (no rheum does that to my knowledge)
  
• Checking if patient has psoriasis, as it is often a comorbidity of psoriasis. 
   
  

I think that is about it.
There is more but rheumatologists do not know that and that is that if you extract the fluid from the swollen joint and you check that under a microscope, they you will see pyruvate chrystals. That in fact is an absolute verdict that you have it. (This knowledge comes from a internist doctor with years of psoriasis experience)