65 - Psoriatic Arthritis and Reactive Arthritis Flashcards
Most widely accepted and define inclusion of participants in PsA clinical trials
Classification criteria for PsA (CASPAR)
A classification of PsA is met if the final score is equal to or more than
3 points
Unlike (psoriasis/PsA) which has a bimodal incidence, (psoriasis/PsA) onset is most commonly seen in adulthood
Psoriasis
PsA
Clinical predictors of PsA
Nail psoriasis
Severe psoriasis
Scalp, intergluteal, or perianal psoriasis
Presence of uveitis
Most common manifestation of clinical nail disease in PsA
Nail pitting
Noncutanaeous findings: ______ in the year prior to diagnosis
Joint pain
Fatigue
Stiffness
5 distinct phenotypes of PsA
Oligoarticular Polyarticular/symmetrical Distal interphalangeal joint predominant Spondyloarthritis Arthritis mutilans
Most common phenotype of PsA
Oligoarticular (>70%)
Joint inflammation in (rheumatoid arthritis/PsA) is more vascular and less tender than in (rheumatoid arthritis/PsA)
PsA
Rheumatoid arthritis
Full-thickness inflammation of a digit (finger or toe)
Dactylitis
Anatomical structures formed by tendon, ligament, and joint capsule insertions on bone
Entheses
Entheses function together with bone and synovium as the _____ to distribute biomechanical stress
Synovio-entheseal complex
Most common sites of involvement in enthesitis
Achilles tendon
Plantar fascia
Lateral epicondyles at the elbows
Inflammatory arthritis affecting the axial skeleton leading to spondylitis and/or sacroiliitis
Spondyloarthritis
Y/N: More commonly, axial PsA overlaps with peripheral PsA
Yes
Risk factors for axial PsA
Onycholysis Inflammatory back pain symptoms PsA duration/young age at onset Positive HLA-B27 Inflammatory bowel disease
Significantly more likely to present with bilateral sacroiliitis, complete ankylosis of the sacroiliac joints, bridging syndesmophytes formed in a caudal to cranial progression, and more severe osteoproliferation than axial PsA
Ankylosing spondylitis
More likely to present as isolated spondylitis, manifest with random syndesmophyte formation, isolated involvement of the cervical spine, and although sacroiliitis is also most commonly symmetric, it is less likely so than in AS
Axial PsA
Eye involvement manifests in a _____ of people with PsA and about _____% in people with psoriasis
Third
10
Uveitis in PsA is much (more/less) than in AS, where uveitis occurs in about 40%
Less
In (axial/peripheral) PsA, uveitis is diagnosed at a younger age than in psoriasis, more likely to present in males who are HLA-B27 positive and more likely to involve the anterior segment
Axial
Uveitis in (axial/peripheral) PsA is more likely to be insidious, bilateral, and to involve the posterior segment
Peripheral
Medical risk factors and comorbidities associated with PsA
Cardiovascular disease Obesity Type 2 DM Nonalcoholic fatty liver disease Metabolic syndrome
Strongest evidence for being a genetic risk factor for PsA in people with psoriasis
HLA-B27
HLA-B27 haplotypes hold prognostic value through association with disease characteristics
PsA onset within 1 year from psoriasis diagnosis Axial PsA Enthesitis Dactylitis Uveitis
Encodes a lymphoid-specific intracellular phosphatase involved in T-cell signaling pathways
Has been associated with rheumatoid arthritis, type 1 diabetes, SLE, and Grave disease
PTPN22
_____ locus is common to inflammatory bowel disease, juvenile idiopathic arthritis, and asthma
5q31
In addition to the clinical factors, the following environmental and individual factors increase the risk of PsA
Physical trauma
Smoking
Overweight
Obese physique
Central to innate immunity in both psoriasis and PsA
TNF-induced NF-kbeta signaling
Adaptive immune system responses in PsA are characterized by selective transcription of mediators favoring
Th1 and Th17 cells
The _____ hypothesis connects damage at entheseal insertion sites in the presence of a genetically susceptible background with erroneous tissue repair responses and self-propagating inflammation leading to PsA
Biomechanical stress/synovio-entheseal complex
Unfortunately, screening questionnaires may miss a significant portion of PsA patients and therefore _____ remains key for detecting PsA
Dermatologists’ high index of suspicion
Laboratory tests for _____ are important to exclude rheumatoid arthritis
Rheumatoid factor
Anticyclic citrullinated peptides (anti-CCP)
Genotyping for _____ has clinical and prognostic value because _____-positive individulals are at higher risk for early PsA, axial PsA, severe enthesitis and uveitis
HLA-B27
Recommended to evaluate PsA characteristic joint damage such as juxta-articular bone erosions and new bone formation
Radiographs
Can distinguish tissue edema and vascularization
Imaging techniques (musculoskeletal ultrasonography and MRI)