Psoriatic Arthritis Flashcards
Explain the presentation of psoriatic arthritis
- History/family history of psoriasis
- Nail changes
- Enthesopathy
- Dactylitis
- Can present with: symmetrical polyarthritis, asymmetric oligoarthritis, arthritis mutilans, spondylitic patterb
What are the psoriasis nail changes?
Pitting
Yellowing
Ridges
Oncholysis
Subungual hyperkeratosis (thickening of nail bed)
What is the treatment of psoriatic arthritis
(NSAIDs for Pain)
1. Conventional synthetic DMARDs eg, methotrexate or leflunomide.
2. Anti-TNF (Infliximab or adalimumab)
3. Ustekinumab
What are the investigations for psoriatic arthritis?
- X-ray which can show - Periostitis, Ankylosis, osteolysis, dactylitis and pencil in cup appearance
- ESR and CRP,
- Rheumatoid factor and anti-CCP antibody,
- Uric acid level
What are the associated conditions with psoriatic arthritis?
Eye disease (conjunctivitis and anterior uveitis)
Aortitis
Amyloidosis
What is arthritis mutilans
Most severe form of psoriatic arthritis. There is progressive osteolysis of the phalanxes which leads to shortening of the fingers
How can you distinquish between RA and psoriatic arthritis?
Psoraitic arthritis affects DIP (which is normally spared in RA).
Dactylitis and sacroiliatis are not seen in RA
Overtime PA can become polyarticular.
What is the presentation of Psoriatic arthritis?
- Symmetrical polyarthritis (can be asymmetrical oligoarthritis)
- Sacroilitis
- DIP joint disease
- Athritis mutilans
- Psoriatic skin lesions
- Periarticular disease (tenosynovitis, enthesitis, dactylitis)
- Nail change
What is the treatment of psoriatic arthritis?
Mild disease - NSAIDs
Mod/severe disease - Methotrexate,
Monoclonal antibodies: Ustekinumab (suppress IL12 and 23), secukinumab,
Apremilast (PDE4 inhibitor)
What are the differential diagnosis of psoriatic arthritis?
- Rheumatoid arthritis,
- Gout,
- Erosive osteoarthritis
- Reactive arthritis
- Mycobacterial tenosynovitis
What are the complications of psoriatic arthritis?
- DVT,
- Treatment related infection,
- Cardiovascular disease,
- Diabetes
- Osteoporosis
- Depression
What are the risk factors for psoriatic arthritis?
- Psoriasis,
- Family history of psoriatic arthtitis/psoriasis
- Obesity,
- Arthralgia,
- Scalp psoriasis
What is the classification criteria system used for psoriatic arthritis?
CASPAR criteria
What is the pathophysiology of psoriatic arthritis?
- Inflammation results in release of cytokines which activate cells such as chondroblasts, osteoblast and osteoclasts
