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Inflammatory Joint Disease and Related Conditions > 21 Psoriatic JIA > Flashcards

21 Psoriatic JIA Flashcards

1
Q

ILAR criteria for PsJIA

A

1) Arthritis + Psoriasis
OR
2) Arthritis + 2/3
-Dactylitis
-Nail pits/onycholysis
-FHx of psoriasis in a 1st degree relative
3) EXCLUSION CRITERIA

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2
Q

ILAR exclusion criteria for PsJIA (5)

A

1) HLA-B27 (+) male after 6th birthday
2) Spondyloarthritides or history of 1 of these in a 1st-degree relative
3) IgM RF on at least 2 occasions at least 3 months apart
4) sJIA
5) Arthritis fulfilling at least 2 JIA categories

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3
Q

First PsJIA criteria

A

Vancouver criteria

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4
Q

Vancouver vs PsJIA criteria

A

Vancouver criteria includes Psoriatic-like rash as a minor criterion and does not include exclusion criteria

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5
Q

Adult vs PsJIA

A

Adult: Most patients have had psoriasis for an average of 5-10 yrs prior to onset of joint disease; Pedia: ~50% present initially with joint disease

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6
Q

T/F Every child with psoriasis and arthritis has psoriatic arthritis

A

F

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7
Q

Age at onset of PsJIA

A

Bimodal: Preschool years (2-3y) then middle to late childhood (adolescence)

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8
Q

PsJIA: Girls vs boys

A

Girls

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9
Q

T/F Synovial biopsy is generally helpful as a diagnostic tool for PsJIA

A

F

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10
Q

Synovio-entheseal complex is a pathology associated with what chronic inflammatory joint disease

A

Psoriatic arthritis

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11
Q

___% of patients with childhood-onset psoriasis, with or without PsJIA have a family history of psoriasis

A

> 50

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12
Q

T/F Environmental contributions play a pivotal role in development of psoriasis and PsA

A

T, limited concordance in monozygotic twins

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13
Q

Environmental triggers identified for psoriasis and PsA

A

Infections
Trauma
Obesity
Cigarette smoking
Emotional stress

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14
Q

Bacteria that has elicited the most attention in terms of triggering psoriasis and potentially PsA

A

Streptococcus

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15
Q

Younger vs older children with PsJIA: More commonly female, ANA (+), affected by dactylitis, and prone to chronic asymptomatic uveitis

A

Younger (before 4-6y)

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16
Q

PsJIA, but not other subtypes of JIA, is linked genetically to this polymorphism that is also associated with PsA in adults

A

Single nucleotide polymorphism in the IL-23 receptor

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17
Q

Clinical differences between oligoarticular JIA and PsJIA

A

1) Tendency to develop dactylitis
2) To involve wrists and small joints of hands and feet
3) And to progress to polyarticular disease in the absence of effective therapy

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18
Q

Younger vs older children with PsJIA: Gender ratio closer to 1:1

A

Older

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19
Q

Younger vs older children with PsJIA: Tendency to enthesitis

A

Older

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20
Q

Younger vs older children with PsJIA: Tendency to axial disease

A

Older

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21
Q

T/F Arthritis in PsJIA begins as polyarthritis in a majority of patients

A

F, oligo

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22
Q

MC joint affected in PsJIA

A

Knee followed by the ankle

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23
Q

PsJIA: Symmetrical vs asymmetrical joint distribution

A

Asymmetrical

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24
Q

Highly destructive form of adult PsA

A

Arthritis mutilans

25
Q

T/F Arthritis mutilans is common in PsJIA

A

F

26
Q

Younger vs older children with PsJIA: Tendency to sacroiliitis

A

Older

27
Q

Younger vs older children with PsJIA: Elevated frequency of HLA B27 antigen

A

Older

28
Q

AS vs PsJIA: Axial disease generally milder

A

PsJIA

29
Q

AS vs PsJIA: Tendency for asymmetrical joint involvement

A

PsJIA

30
Q

AS vs PsJIA: Tendency to progress to spinal ankylosis

A

AS

31
Q

Typical sites of symptomatic enthesitis

A

1) Insertion of Achilles tendon into calcaneus
2) Insertions of the plantar fascia

32
Q

Suspected enthesitis can be confirmed by

A

UTZ or MRI

33
Q

MC digit affected by dactylitis in patients with PsJIA

A

2nd toe and index finger

34
Q

Form of psoriasis present in a large majority of patients with PsJIA

A

Classic vulgaris

35
Q

T/F Psoriasis in children tends to be subtle

A

T

36
Q

A substantial difference between children with PsJIA and psoriasis without arthritis

A

Prevalence of nail changes in PsJIA

37
Q

Psoriatic changes in nails surface

A

Pits, onycholysis, horizontal ridging, discoloration

38
Q

Acute anterior uveitis is associated with the presence of what antigen

A

HLA-B27

39
Q

T/F ESR and CRP in PsJIA are frequently normal

A

T

40
Q

T/F RF is typically absent in PsJIA

A

T

41
Q

The basic treatment algorithm for PsJIA is similar to that employed in

A

Other subtypes of JIA:
1) NSAIDs initially but do not induce remission and inappropriate as extended monotherapy
2) Glucocorticoid injection for individual large joinrs
3) DMARDs (sulfasalazine, MTX) for multiple joint involvement
4) TNFi when there is inadequate response to the above

42
Q

Secukinumab

A

Anti-IL17

43
Q

Ustekinumab

A

Anti-IL-12/23

44
Q

Tofacitinib

A

Jak inhibitor

45
Q

Apremilast

A

PDE 4 inhibitor

46
Q

T/F No particular TNFi has been shown to be superior to another in PsJIA

A

T

47
Q

T/F PsJIA is thought to be less responsive to systemic or intraarticular corticosteroids than other types of arthritis

A

T

48
Q

Substantial doses of corticosteroids are avoided when possible in PsJIA because

A

It can provoke a flare of cutaneous psoriasis when tapered

49
Q

Antimalarials are avoided in PsJIA because

A

Can worsen cutaneous psoriasis

50
Q

Medications used to treat PsA: csDMARDs

A

Skin
Peripheral arthritis
No data for enthesitis/dactylitis
Not for axial arthritis

51
Q

Medications used to treat PsA: TNF blockade

A

Skin
Peripheral arthritis
Enthesitis/dactylitis
Axial arthritis

52
Q

Medications used to treat PsA: CTLA4-Ig

A

Peripheral arthritis
Not for the rest

53
Q

Medications used to treat PsA: IL-6 blockade

A

+/- for peripheral arthritis and enthesitis/dactylitis
NOT for the rest

54
Q

Medications used to treat PsA: IL-17 blockade

A

Skin
Peripheral arthritis
Enthesitis/dactylitis
Axial arthritis

55
Q

Medications used to treat PsA: IL-12/23 blockade

A

Skin
Peripheral arthritis
Enthesitis/dactylitis
Axial arthritis

56
Q

Medications used to treat PsA: Jak Inhibition

A

Skin
Peripheral arthritis
Enthesitis/dactylitis
Axial arthritis

57
Q

Medications used to treat PsA: PDE inhibition

A

Skin
Peripheral arthritis
Enthesitis/dactylitis
No data for axial arthritis

58
Q

Medications used to treat PsA: Highly effective for axial disease

A

TNFi and anti-IL-17

59
Q

Medications used to treat PsA: Resistant sacroiliitis may be treated with

A

Local corticosteroid injections

Inflammatory Joint Disease and Related Conditions (2 decks)

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