Diagnosis and management of psoriasis and psoriatic arthritis in adults: summary of SIGN guidance

The degree of disability and negative impact on quality of life caused by psoriasis and psoriatic arthritis are comparable to those of ischaemic heart disease, diabetes, depression, and cancer.1 Severe psoriasis and psoriatic arthritis are associated with an increased risk of conditions such as cardiovascular disease, diabetes, and depression.2 3 4 5 Psoriatic arthritis is underdiagnosed; about a fifth of patients with psoriasis also have psoriatic arthritis.6 The management of patients with both conditions may be particularly challenging and require close collaboration among several specialties. This article summarises the most recent recommendations from the Scottish Intercollegiate Guidelines Network (SIGN) on the diagnosis and management of psoriasis and psoriatic arthritis in adults.7 SIGN recommendations are based on systematic reviews of best available evidence. The strength of the evidence is graded as A, B, C, or D (fig 1⇓), but the grading does not reflect the clinical importance of the recommendations. Recommended best practice (“good practice points”), based on the clinical experience of the guideline development group, is also indicated (as GPP). Fig 1 Explanation of SIGN grades of recommendations ### Diagnosis and assessment in primary care