PSORIATIC ARTHRITIS

Question 1

Define psoriatic arthritis.

Answer 1

Chronic autoimmune inflammatory arthritis associated with psoriasis.

Question 2

What is psoriasis?

Answer 2

Psoriasis is a common condition where there is inflammation of the skin. It typically develops as patches (plaques) of red, scaly skin. Once you develop psoriasis it tends to come and go throughout life.

Question 3

Is psoriasis infectious?

Answer 3

No.

Question 4

What percentage of psoriasis sufferers develop arthritis?

Answer 4

8%

Question 5

What are the different types of psoriatic arthritis?

Answer 5

Seronegative symmetrical polyarthritis
Asymmetric oligoarticular arthritis
Lone distal interphalangeal arthritis
Arthritis mutilans
Spondylitic pattern +/- sacroiliitis
Juvenile onset psoriatic arthritis

Question 6

Which joints are most often affected in seronegative symmetrical polyarthritis?

Answer 6

Wrists
Ankles
Feet
Fingers

Question 7

On examination, how might you differentiate seronegative symmetrical polyarthritis from rheumatoid arthritis?

Answer 7

The DIP joints are often involved rather than the MCP joints

No skin nodules

Question 8

Which joints are most commonly affected by asymmetric oligoarticular arthritis?

Answer 8

Hands

Feet

Question 9

How many joints, by definition, are affected by asymmetric oligoarticular arthritis?

Answer 9

Oligo – 1-5 joints

Question 10

Other than joint pain, what signs and symptoms might be present in someone with asymmetric oligoarticular arthritis?

Answer 10

Enthesopathy
Dactylitis
Nail dystrophy
Cutaneous lesions (psoriasis)
Interphalangeal joint synovitis
Tenosynovitis

Question 11

Which joints are most affected by lone distal interphalangeal disease?

Answer 11

Distal interphalangeal joints

Question 12

Are men or women more likely to develop lone distal interphalangeal disease?

Answer 12

Men

Question 13

How is the affected nail and DIP described in someone with lone distal interphalangeal disease?

Answer 13

Hammer blow appearance

Question 14

Which joints are most often affected in arthritis mutilans?

Answer 14

DIP

PIP

Question 15

Other than joint pain, what other signs might be seen in the hand of someone with arthritis mutilans?

Answer 15

Telescoping

Question 16

What causes telescoping in the fingers of patients with arthritis mutilans?

Answer 16

Periarticular osteolysis and bone shortening

Question 17

What percentage of patients with psoriatic arthritis are affected by arthritis mutilans?

Answer 17

5%

Question 18

Are men or women more likely to develop the spondylitic pattern (+/- sacroiliitis) of psoriatic arthritis?

Answer 18

Men

Question 19

What are the symptoms of the spondylitic pattern (+/- sacroiliitis) of psoriatic arthritis?

Answer 19

Morning back stiffness

Movement limitation

Question 20

What might be seen on the radiograph of someone with the spondylitic pattern (+/- sacroiliitis) of psoriatic arthritis?

Answer 20

Syndesmophytes
Paravertebral ossification
Fusion of vertebral bodies
Calcified intervertebral discs

Question 21

Are vertebrae affected symmetrically or asymmetrically in the spondylitic pattern (+/- sacroiliitis) of psoriatic arthritis?

Answer 21

Asymmetrically

Question 22

From a radiograph, how might you diagnose the spondylitic pattern (+/- sacroiliitis) of psoriatic arthritis instead of ankylosing spondylitis?

Answer 22

In ankylosing spondylitis, vertebrae are normally affected symmetrical. This is not the case in the spondylitic pattern (+/- sacroiliitis) of psoriatic arthritis.

Question 23

What are the CASPAR diagnostic criteria for diagnosing psoriatic arthritis?

Answer 23

Inflammatory articular disease plus 3 points worth of the following:

Psoriasis (2)
History of psoriasis (1)
Family history of psoriasis (1)
Psoriatic nail dystrophy (1)
Negative RF (1)
Current dactylitis (1)
History of dactylitis (1)
Jaxta-artciular new bone (1)

Question 24

What the pharmacological treatment options for patients with psoriatic arthritis?

Answer 24

DMARDs (Leflunomide, Sulfasalazine, Methotrexate)
NSAIDs
Steroid injections
Cytokine modulators (adalimumab, etanercept, golimumab and infliximab)

Question 25

Why might oral steroids not be a good treatment option in someone with psoriatic arthritis?

Answer 25

Oral steroids may cause rebound exacerbations of skin lesions.

Question 26

What group of diseases does psoriatic arthritis fall under?

Answer 26

Seronegative Spondyloarthropathies

Question 27

What is the surface antigen associated with psoriatic arthritis?

Answer 27

HLA-B27