Psoriatic arthritis

Question 1

What is Psoriatic arthritis ?

Answer 1

Psoriatic arthropathy (arthritis) typically causes joints to become swollen, stiff and painful. This is a long-term condition that can get progressively worse leading to bony erosions and other articular manifestations.

Its an autoimmune condition

Question 2

What causes (or triggers) Psoriatic arthritis?

Answer 2

• Cold weather
• Environmental stresses
• Alcohol
• UTI, GU, GI Infections
• Emotional or physical trauma
• Smoking
• Weight gain
• Viral or Bacterial infections

common to many autoimmune diseases

Question 3

What is the pathophysiology of Psoriatic arthritis?

Answer 3

• Immune-mediated, inflammatory arthropathy
• Inflammation at the entheses (where the connective tissues are attached to the bone).
• Associated with increased mortality from cardiovascular disease - as affects connective tissues around the heart.
• Caused by activation of cytokines, Tumour Necrosis Factor (TNF) and Interleukins.
• Cascade of immune cells incl. phagocytes cause tissue damage. As they clear damage they cause more damage…

Question 4

What are the signs and symptoms of Psoriatic arthritis?

Answer 4

• Oligoarticular & polyarticular - one or many joints, can affect all the joints in fingers and toes. Also pitting and discolouration in the nails
• RA-like effects
• Eye inflam.(Uveitis)
• Bone erosion which can lead to Arthritis Mutilans - joint looks like it has been mutilated
• Swollen fingers & toes - become sausage-like
• Tendon & ligament inflam. (Fibromyalgia)
• Osteoporosis in long term cases
• Non-articular manifestations E.g. Uveitis, CVS, metabolic

Prevalence
* Psoriasis affects up to 2% of the population
* Psoriatic arthritis develops in 10-40% of patients
* 80% of patients develop arthritis after 10 years or more
* Equal Male : Female
* In USA 3.6% whites, 1.9% African-Americans, 1.6% Hispanics

Question 5

What are typical tests and treatments for Psoriatic arthritis?

Answer 5

There is no single test to diagnose psoriatic arthritis. But people with Psoriasis should be investigated with:
* Skin biopsy (to check its psoriasis not excema)
* Blood tests: FBC, ESR, CRP, Rheumatoid factor, HLA (B27), Anti-Cyclic Citrullinated Peptide test, Serum uric acid
* X-rays of affected joints.
* CT & MRI scans

Pharmacological management of Psoriasis
Psoriasis (Topical)
* Topical Corticosteroids
* Vitamin D analogues
* Retinoid drugs
* Calcineurin inhibitors
* Salicylic acid
* Coal tar
* Anthralin
* Light therapy

Psoriasis (Internal)
* Steroids
* Retinoids
* Methotrexate
* Cyclosporine
* Biologic agents: Etanercept, Apremilast, Infliximab

Other treatment & management of Psoriatic arthritis
* Topical injections
* Physical therapies
* Occupational therapy
* Exercise
* Podiatry (sore heels and feet)
* Diet & lifestyle management
* Joint replacement