Psoriatic & Reactive Arthritis Flashcards
(32 cards)
7-10% of patients with ____ develop psoriatic arthritis
psoriasis
A patient with more surfaces of rough skin and bad dandruff is at most risk of developing ____
joint symptoms (psoriatic arthritis)
(more severe psoriasis = ^risk)
Where is psoriasis usually located?
- extensor surfaces around elbows
- knees
- scalp (dandruff)
In a patient with psoriatic arthritis, ____ symptoms precede ____ symptoms
skin; joint
At what age do joint symptoms tend to manifest in patients with psoriatic arthritis?
between 30-50yrs
What joints are commonly affected by psoriatic arthritis?
- SI & thoracolumbar spine
- DIP jts of hands & feet
Histologically, psoriatic arthritis is similar to ____
RA
The earliest manifestation of psoriatic arthritis is in what joints?
DIP (hands)
How does psoriatic arthritis compare to RA?
- histologically similar
- less severe than RA
- more frequent remissions
- less jt destruction
- normal bone density
- asymmetric
What gene is implicated in psoriatic arthritis?
HLA-B27
What are the 2 primary histologic characteristics of psoriasis?
hyperkeratosis
parakeratosis
What is hyperkeratosis?
over proliferation of keratinocytes
How does the doubling time of keratinocytes in psoriasis compare to normal?
normal = 21 days
psoriasis = 3 days (hyperkeratosis)
What is parakeratosis?
persistence of nuclei in stratum corneum cells
(results in ^shedding of skin cells)
What are the clinical manifestations of psoriatic arthritis?
- psoriatic skin rash (flares coincide w/ jt Sx)
- dactylitis
- asymmetrical stiffness & pain (after inactivity)
- pitting (deep grooves) of finger/toe nails
- onycholysis
Describe the appearance of a psoriatic skin rash
- reddish (pinpoint hemorrhagic foci) plaques with white/silvery scale
- well-defined, inflamed borders
- neutrophilic pustules may be present
Swelling around the joints of the fingers is called ____
spindle digits
(dactylitis)
Swelling of the entire length of the digits is called ____
sausage digits
In psoriatic arthritis, dactylitis initially presents as ____, and may progress to ____
spindle digits
sausage digits
What is onycholysis?
painless separation of the nail from the bed
What are the common radiographic characteristics of psoriatic and reactive arthritis in the spine?
- marginal erosions
- fluffy periostitis
- normal bone density
- uniform narrowing of jt space
- asymmetrical sacroiliitis (bilat. or unilat.)
- paravertebral ossifications (non-marginal syndesmophytes)
- osseous ankylosis
What are the radiographic characteristics specific to psoriatic arthritis?
- marginal erosions & fluffy periostitis producing deformities (mouse ear, pencil-in-cup)
- osseous ankylosis of digits
What is another name for reactive arthritis that should not be used?
Reiter’s syndrome
What demographic is primarily affected by reactive arthritis?
- almost exclusively men (men are sluts; 50:1)
- onset in 20-30s
(historically seen in military populations)
