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Clinical lectures > Psoriatic artritis > Flashcards

Psoriatic artritis Flashcards

1
Q

What percentage range of the whole population is affected by psoriasis?

A

1-3%

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2
Q

What percentage of individuals with psoriasis later develop psoriatic arthritis?

A

Up to 40%

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3
Q

What percentage of all arthritic patients develop psoriasis?

A

20%

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4
Q

In terms of cases of psoriatic arthritis, how may cases had arthritis before developing psoriasis?

A

Up to 60%

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5
Q

What is the prevalence of PsA compared to RA?

A

PsA prevalence is 0.67, RA prevalence is 0.8 which is greater

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6
Q

What is the ratio of female to male individuals with PsA?

A

2:1

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7
Q

Does the extent of psoriasis correlate strongly with the progression of arthritis?

A

No, there is a weak correlation

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8
Q

What age range is the usual onset of psoriatic arthritis?

A

30-55 years old

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9
Q

What are the 5 clinical subsets of PsA, and what percentage of all PsA cases do they each make up?

A

Asymmetrical olgioarthritis (40%)

Symmetrical polyarthritis (30%)

Distal interphalangeal joint arthritis (10-15%)

Psoriatic spondylitis (10-20%)

Arthritis mutilans (less than 10%)

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10
Q

In asymmetrical oligoarthritis PsA, are upper or lower limbs affected?

A

Both upper and lower limbs are affected

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11
Q

In asymmetrical oligoarthritis PsA, how many large and small joints are usually affected?

A

Up to 1-2 large joints and some small joints, so that overall up to 4 joints are affected

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12
Q

In asymmetrical oligoarthritis PsA, are the same joints affected on both sides of the body?

A

No, joints on one side of body are affected only

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13
Q

In asymmetrical oligoarthritis PsA, give 3 examples of commonly affected joints ?

A

Knees, hips, distal ends of extremities

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14
Q

In asymmetrical oligoarthritis PsA, list 7 common symptoms?

A

onycholysis (nail separates from nail bed), nail pitting, enthesitis, psoriasis patches, uveitis, joint inflammation, dactylitis

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15
Q

What is dactylitis?

A

severe swelling of digit caused by involvement of synovitis of the digit, enthesitis and inflammation of intervening tissue

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16
Q

In symmetrical polyarthritis PsA, what is meant by symmetrical?

A

Affect same joints on both sides of body

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17
Q

In symmetrical polyarthritis PsA, how many large and/or small joints are affected?

A

5 or more large and/or small joints

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18
Q

In symmetrical polyarthritis PsA, is the upper or lower limb affected?

A

Both upper and lower limbs are affected

19
Q

In symmetrical polyarthritis PsA, are small or large joints more commonly affected?

A

Small joints more commonly affected

20
Q

In symmetrical polyarthritis PsA, what joints are commonly affected?

A

Small joints in hands and feet

21
Q

In symmetrical polyarthritis PsA, what are the common symptoms?

A

Same symptoms that present in asymmetrical oligoarthritis

22
Q

In symmetrical polyarthritis PsA, give 2 reasons why it is mistaken for RA?

A

Both are symmetrical and commonly affect small joints

23
Q

In symmetrical polyarthritis PsA, give 2 reasons how it is different from RA?

A

Seronegative RF

No extra-articular features of RA eg. no rheumatoid nodules

24
Q

In Distal interphalangeal joint arthritis PsA, what joints are mainly affected?

A

Distal interphalangeal joints in extremities (fingers and toes)

25
Q

In Distal interphalangeal joint arthritis PsA, is it asymmetrical or symmetrical?

A

Can be asymmetrical or symmetrical

26
Q

Is Distal interphalangeal joint arthritis PsA more common in men or women?

A

More common in men

27
Q

In Distal interphalangeal joint arthritis PsA, list 4 common symptoms?

A

nail pitting, cracking, onycholysis, accompanying nail disease

28
Q

In psoriatic spondylitis PsA, what joints are mainly affected?

A

Vertebral joints

29
Q

In psoriatic spondylitis PsA, list 4 common symptoms?

A

Inflammatory back pain, inflammatory neck pain, limited mobility, stiffness

30
Q

In psoriatic spondylitis PsA, what 5 joints can also be affected?

A

hips, arms, legs, hands, feet

31
Q

What is the most severe subset of PsA?

A

Arthritis mutilans

32
Q

In arthritis mutilans PsA, what joints are mainly affected?

A

Small joints in hand, fingers, wrist

33
Q

In arthritis mutilans PsA, how are joints and bones affected by the severe inflammation?

A

Severe inflammation causes joint deformities and bone erosion which leads to shortening of digits and limited mobility

34
Q

List 5 examples of extra-articular features of PsA?

A

Skin lesions

Nail changes eg. pitting, onycholysis (separation of the nail from the nail bed) and subungual hyperkeratosis

Uveitis (HLA B27 positive cases)

Mouth ulcers

Colitis

35
Q

In PsA, what 2 inflammatory markers are elevated?

A

ESR, CRP

36
Q

In PsA, what 3 markers are seronegative?

A

RF
ANA (antinuclear antibodies)
anti-CCP

37
Q

Give 3 examples of radiological changes of PsA that are seen with x-ray?

A

Bone erosion with narrow joint space

soft tissue swelling

Pencil in cup bone chape

38
Q

What causes the pencil in cup bone shape to form in PsA?

A

Severe digit erosion and heterotrophic (extra-skeletal) horizontal bone formation

39
Q

If there is axial involvement in PsA, what 2 radiological features are seen?

A

Sacroiliac joint changes

Syndesmophytes

40
Q

What radiological feature of PsA is shown with MRI or ultrasound?

A

enthesitis

41
Q

What 2 types of medications can be used for mild PsA

A

Analgesics

NSAIDs

42
Q

What 5 medications are recommended for peripheral joint disease?

A

Methotrexate MTX
Sulfasalazine SZP
Leflunomide LFN
Apreimilast
Cyclosporin CyA

43
Q

When can biologics be used to treat PsA?

A

PsA is unresponsive to DMARDs, usekinumab and secukinumab (monoclonal antibodies for resistant cases)

44
Q

How should you treat a patient in which skin activity mirrors joint activity?

A

Treat skin disease, then joints will improve

Clinical lectures (29 decks)

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