Synopsis
Recognise peripheral spondyloarthritis from arthritis, enthesitis and dactylitis plus associated features, exclude urgent infection, and select therapy according to the dominant peripheral and extra-articular domains.
- Peripheral spondyloarthritis is recognised from asymmetric arthritis, enthesitis or dactylitis plus psoriasis, uveitis, bowel disease, recent infection, axial symptoms or family history.
- Inspect skin, scalp, nails and hidden flexures and ask about eye, bowel and genitourinary disease even when the referral says isolated tendon pain.
- HLA-B27 and inflammatory markers can support but neither confirm nor exclude peripheral disease.
Key red flags
Pain, photophobia, redness and blurred vision needs same-day ophthalmic assessment and should be communicated to rheumatology.
Investigation priorities
Document peripheral joints, entheses, dactylitis, axial signs, skin, nail, eye and bowel associations.
Management branches
Persistent asymmetric arthritis, dactylitis or multisite enthesitis lacks an acute infection signal.
- Map joints, entheses, digits, spine, skin, nails and eye or bowel history and obtain baseline treatment-safety tests.
- Refer to rheumatology through the peripheral spondyloarthritis pathway, highlighting psoriasis, uveitis, IBD, infection and family history.
Key medicines
NaproxenCommon adult dosing is 250–500 mg orally twice daily with food for a reviewed trial when risk permits.
SulfasalazineCommonly started at 500 mg once daily and increased gradually toward 1 g twice daily under specialist monitoring.