MBBS OSCE · General Medicine
OSCE — Psoriatic Arthritis
Eight-minute OSCE station on Psoriatic Arthritis: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Psoriatic Arthritis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, usually rheumatoid-factor negative, classified within the seronegative spondyloarthropathies. Diagnosis is clinical using the CASPAR criteria (established inflammatory articular disease plus at least 3 points from current psoriasis, personal or family history of psoriasis, current or historical dactylitis, juxta-articular new bone formation, rheumatoid-factor negativity, and nail dystrophy). The five Moll and Wright patterns are asymmetric oligoarthritis (commonest), symmetric polyarthritis, DIP-predominant, arthritis mutilans, and predominant spondylitis or sacroiliitis. Hallmarks: dactylitis (sausage digit),
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Inflammatory arthritis with psoriasis and/or nail dystrophy (pitting, onycholysi |
| Safety | Sausage digit (dactylitis) with enthesitis and nail changes - seronegative spond |
| Safety | Pencil-in-cup deformity or fluffy periostitis on X-ray of a DIP joint - psoriati |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.