[7] Psoriatic Arthritis

Question 1

What is psoriatic arthritis?

Answer 1

Psoriatic arthritis is a long-term inflammation arthritis that occurs in people affected by the autoimmune disease psoriasis.

Question 2

What % of people with psoriasis will develop psoriatic arthritis?

Answer 2

About 30%

Question 3

What joints are affected in psoriatic arthritis?

Answer 3

The joints at the end of the fingers are most commonly affected, however the wrists, knees, and ankles can also be involved.

Question 4

What comes first, the psoriasis or the arthritis?

Answer 4

In most cases (but not always), the psoriasis will precede the arthritis, sometimes by may years

Question 5

What are the joint symptoms in psoriatric arthritis often accompanied by?

Answer 5

Symptoms in fingernails and toenails

Question 6

What are the symptoms of psoriatic arthritis?

Answer 6

• Swelling of entire fingers and toes, with sausage like appearance
• Changes to nails, such as pitting, thickening, and detatchment from nailbed
• Classic symptoms of arthritis, including general joint pain and stiffness (especially in morning), joint swelling, reduced range of motion etc
• Classic symptoms of psoriasis, including psoriatic skin lesions
• Generalised fatigue

Question 7

How is a diagnosis of psoriatic arthritis made?

Answer 7

There is no definitive test to diagnose psoriatic arthritis, so diagnosis is made on the basis of examination, history, and blood tests

Question 8

What factors contribute to a diagnosis of psoriatic arthritis?

Answer 8

• Psoriasis in teh patient, or family history of psoriasis/psoriatric arthritis
• Negative test for rheumatoid factor
• Arthritis symptoms
• Fingernail changes
• Radiological images showing degenerative changes

Question 9

What are the management options in psoriatic arthritis?

Answer 9

• NSAIDs
• DMARDs
• Biological agents
• Low-level laser therapy
• Corticosteroid injections
• Joint surgery

Both the skin and joint components of psoriatic arthritis must be treated

Question 10

When are NSAIDs used in psoriatic arthritis?

Answer 10

In milder cases, if they are sufficient

Question 11

What are the first line NSAIDs in psoriatic arthritis?

Answer 11

Ibuprofen and naproxen

Question 12

What are the second line NSAIDs in psoriatic arthritis?

Answer 12

Stronger agents such as diclofenac and indamethacin

Question 13

What should be co-prescribed with NSAIDs in psoriatic arthritis?

Answer 13

PPI

Question 14

What can be prescribed as an alternative to NSAIDs in psoriatic arthritis?

Answer 14

COX-2 inhibitors

Question 15

What is the advantage of COX-2 inhibitors over NSAIDs?

Answer 15

There is less of a risk of GI ulcers or bleeding

Question 16

What are the disadvantages of COX-2 inhibitors over NSAIDs?

Answer 16

There is an increased risk of cardiovascular events

Question 17

When are DMARDs used in psoriatic arthritis?

Answer 17

In persistent symptomatic cases with exacerbation

Question 18

What is the effect of DMARDs in psoriatic arthritis?

Answer 18

They reduce pain and inflammation, and limit the amount of joint damage that occurs

Question 19

What DMARDs are commonly used in psoriatic arthritis?

Answer 19

Methotrexate and leflunomide, however others are available

Question 20

What is the advantage of the use of DMARDs in psoriatic arthritis?

Answer 20

They can also relieve psoriasis skin symptoms

Question 21

What are the disadvantages of the use of DMARDs in psoriatic arthritis?

Answer 21

• Can lead to liver and kidney problems
• Increased risk of serious infection

Question 22

Give three examples of anti-TNF agents used in psoriatic arthritis?

Answer 22

• Infliximab
• Etanercept
• Golimumab

Question 23

How do anti-TNF agents work?

Answer 23

They target specific parts of the immune system to reduce symptoms

Question 24

What is the advantage of anti-TNF agents over DMARDs?

Answer 24

They caused less collateral damage

Question 25

What is the problem with the use of anti-TNF antibodies in psoriatic arthritis?

Answer 25

* May increase the risk of minor or serious infections * Can be associated with nervous system disorders, blood disorders, or certain types of cancers

Question 26

What effect does low level laser therapy have in psoriatic arthritis?

Answer 26

It can relieve pain and stiffness associated with the arthritis, as well as treating the skin component

Question 27

When might corticosteroid injections be used in psoriatic arthritis?

Answer 27

When one joint is severely affected

Question 28

What % of people with psoriatic arthritis will develop psoriatic spondylitis?

Answer 28

20%

Question 29

What is psoriatic spondylitis?

Answer 29

Spinal involvement in the disease, where inflammation of the spine leads to complete fusion. Alternatively, it can only affect certain areas, such as the lower back or neck

Question 30

How is HLA-B27 associated with psoriatic spondylitis?

Answer 30

Patients who are HLA-B27 positive are much more likely than others to have disease that progresses to the spine

Question 31

How can psoriatic arthritis affect the eyes?

Answer 31

Psoriatic arthritis is associated with inflammatory eye conditions that cause redness, pain, blurred vision, and light sensitivity

Question 32

What % of people with psoriatic arthritis have conjunctivitis?

Answer 32

30%

Question 33

What % of people with psoriatic arthritis have iritis?

Answer 33

7%