PsA Flashcards
(4 cards)
Name the five (5) clinical variants of Psoriatic arthritis (PsA). In each case, describe the number and type of joints typically affected in each variant
Peripheral Type: most common
o DIPS affected
• Predominantly affects M
Peripheral Symmetric:
• ‘relatively’ symmetric, but more symmetry than other types of PA
• ankylosis of DIPs and PIPs
• hands, wrists, ankles, feet
• NB. important to differentiate from RA!!
Monoarticular /
Asymetrical: Hands & feet (+/- dactylitis)
• hands and feet affected first -> PIPs / DIPs / MCPs
• generally mild, slow progression
Sacrolitis / Spondylitis: axial skeleton affected
Arthritis Mutilians (5% Pts) • very destructive
Describe the typical pathological processes seen in the joints affected by PsA.
• Processes / changes are similar to RA ie
o chronic synovitis
o Lymphocyte infiltration
o exudation
o fibrosis
o severe destruction of cartilage and bone (arthritis mutilans)
o no rheumatoid nodules
o 30% of patients have spine and sacroiliac changes similar to ankylosing spondylitis
Describe the typical presentation of PsA.
- Morning stiffness
- Fatugue
- Hx of psoriatic skin lesions (mid-late 20s as initial onset)
- Nail defects
- Dactylitis (sausage fingers / toes)
- Redness / pain in eye (anterior uveitis / conjunctivitis)
- usually affects some of IP joints of the fingers/toes
- asymmetrical polyarthritis
- slow progression → may become quiescent
What is the temporal relationship between psoriasis and PsA?
a. skin lesions/manifestations usually precede arthritic manifestations (85% of cases)
b. skin lesions may not be active even though the arthritis is
c. skin lesions may be difficult to see
NB. 30% of patients have ocular inflammation (anterior uveitis)
