Psoriatic Arthritis

Question 1

Definiton of psoriatic arthritis

Answer 1

• Inflamatory arthritis associated wth arthritis
• Part of the seronegative spondyloarthropathy conditions

Question 2

Patterns of psoriatic arthritis

Answer 2

• Several recognised patterns:
  
  • Symmetrical polyarthritis
    
    • Similar to RA
    • Hands, wrists, ankles and DIP joints
  • Asymmetrical pauciarthritis
    
    • Affects mainly the digits and feet
  • Spondylitic pattern
    
    • Back stiffness
    • Sacroilitis
    • Atlanto-axial joint involvement
  • Other areas
    
    • Spine
    • Achilles tendon
    • Plantar fascia

Question 3

Signs of psoriatic arthritis

Answer 3

• Placques of psoriasis on the skin
• Pitting of the nails
• Onycholysis (seperation of the nail from the nail bed)
• Dactylitis (inflammation of the full finger)
• Enthesitis (inflammation of the entheses)

Question 4

Associations with psoriatic arthritis

Answer 4

• Eye disease (conjunctivitis and anterior uveitis)
• Aortitis
• Amyloidosis

Question 5

Screening tools

Answer 5

• Psoriasis Epidemiological Screening Tool (PEST)
• Involves questions about joint pain, swelling, Hx of arthritis and nail pitting

Question 6

X-ray changes in psoriatic arthritis

Answer 6

• Periostitis (inflammation of the periosteum causing thickened and irregular outline of the bone)
• Ankylosis (bones joining together causing stiffening)
• Osteolysis (destruction of bone)
• Dactylitis (inflammation of whole digit - appears as soft tissue swelling)
• Pencil-in-cup appearance

Question 7

Arthritis mutilans

Answer 7

• Most severe form of psoriatic arthritis
• Occurs in the phalanxes
• Destruction of the bones around joints in digits leading to progressive shortening of the digits

Question 8

Management of psoriatic arthritis

Answer 8

• Similar to RA
• Often coordinated between dermatology and rheumatology
• NSAIDs for pain
• DMARDs
• Anti0TNF
• Ustekinumab is last line and is a monoclonal antibody that targets interleukin 12 and 23