Psoriatic Arthritis

Question 1

What is psoriatic arthritis associated with

Answer 1

HLA-B27

70% psoriasis precedes arthritis
15% arthritis precedes psoriasis
15% skin and joint manifestations develop simultaneously

Question 2

Symptoms of psoriatic arthritis

Answer 2

Pain and stiffness in joints: Symmetrical polyarthritis / asymmetrical oligoarthritis
Hx psoriasis
Nail changes
Back pain
Finger swelling (dactylitis)
Eye pain (uveitis)
Fatigue

Question 3

Signs of psoriatic arthritis

Answer 3

Psoriasis rash: Purple/silver plaques over extensor surface. Scaly
Nail changes: Pitting, Onycholysis
Arthritis mutilans
Uveitis, dactylitis

Question 4

Investigations for psoriatic arthritis

Answer 4

FBC: normcoytic anaemia
CRP/ESR: raised
HLA-B27: +ve
RhF: negative

X-ray: pencil in cup abnormality
MRI: sacroiliitis, enthesitis
Joint aspiration: sterile, cloudy fluid, raised WCC

Question 5

What is the criteria for psoriatic arthritis

Answer 5

CASPAR
PMHx/FHx psoriasis (2 current, 1 Hx)
Psoriatic nail dystrophy (1)
-ve RhF (1)
Dactylitis (1)
X-ray: juxta-articular new bone formation (1)

Needs 3 points

Question 6

Management for psoriatic arthritis

Answer 6

Peripheral joint disease
- Mild: physiotherapy | NSAIDs
- Moderate-severe: methotrexate
- Severe: biologics e.g. Anti-TNF | Anti-IL-17R e.g. secukinumab

Spondylitis
- Mild: physiotherapy, NSAIDs
- Moderate-severe: biologic

AVOID steroids