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4: Y4 - Rheumatology [19] > [7] Psoriatic Arthritis > Flashcards

[7] Psoriatic Arthritis Flashcards

1
Q

What is psoriatic arthritis?

A

Psoriatic arthritis is a long-term inflammation arthritis that occurs in people affected by the autoimmune disease psoriasis.

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2
Q

What % of people with psoriasis will develop psoriatic arthritis?

A

About 30%

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3
Q

What joints are affected in psoriatic arthritis?

A

The joints at the end of the fingers are most commonly affected, however the wrists, knees, and ankles can also be involved.

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4
Q

What comes first, the psoriasis or the arthritis?

A

In most cases (but not always), the psoriasis will precede the arthritis, sometimes by may years

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5
Q

What are the joint symptoms in psoriatric arthritis often accompanied by?

A

Symptoms in fingernails and toenails

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6
Q

What are the symptoms of psoriatic arthritis?

A
  • Swelling of entire fingers and toes, with sausage like appearance
  • Changes to nails, such as pitting, thickening, and detatchment from nailbed
  • Classic symptoms of arthritis, including general joint pain and stiffness (especially in morning), joint swelling, reduced range of motion etc
  • Classic symptoms of psoriasis, including psoriatic skin lesions
  • Generalised fatigue
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7
Q

How is a diagnosis of psoriatic arthritis made?

A

There is no definitive test to diagnose psoriatic arthritis, so diagnosis is made on the basis of examination, history, and blood tests

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8
Q

What factors contribute to a diagnosis of psoriatic arthritis?

A
  • Psoriasis in teh patient, or family history of psoriasis/psoriatric arthritis
  • Negative test for rheumatoid factor
  • Arthritis symptoms
  • Fingernail changes
  • Radiological images showing degenerative changes
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9
Q

What are the management options in psoriatic arthritis?

A
  • NSAIDs
  • DMARDs
  • Biological agents
  • Low-level laser therapy
  • Corticosteroid injections
  • Joint surgery

Both the skin and joint components of psoriatic arthritis must be treated

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10
Q

When are NSAIDs used in psoriatic arthritis?

A

In milder cases, if they are sufficient

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11
Q

What are the first line NSAIDs in psoriatic arthritis?

A

Ibuprofen and naproxen

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12
Q

What are the second line NSAIDs in psoriatic arthritis?

A

Stronger agents such as diclofenac and indamethacin

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13
Q

What should be co-prescribed with NSAIDs in psoriatic arthritis?

A

PPI

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14
Q

What can be prescribed as an alternative to NSAIDs in psoriatic arthritis?

A

COX-2 inhibitors

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15
Q

What is the advantage of COX-2 inhibitors over NSAIDs?

A

There is less of a risk of GI ulcers or bleeding

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16
Q

What are the disadvantages of COX-2 inhibitors over NSAIDs?

A

There is an increased risk of cardiovascular events

17
Q

When are DMARDs used in psoriatic arthritis?

A

In persistent symptomatic cases with exacerbation

18
Q

What is the effect of DMARDs in psoriatic arthritis?

A

They reduce pain and inflammation, and limit the amount of joint damage that occurs

19
Q

What DMARDs are commonly used in psoriatic arthritis?

A

Methotrexate and leflunomide, however others are available

20
Q

What is the advantage of the use of DMARDs in psoriatic arthritis?

A

They can also relieve psoriasis skin symptoms

21
Q

What are the disadvantages of the use of DMARDs in psoriatic arthritis?

A
  • Can lead to liver and kidney problems
  • Increased risk of serious infection
22
Q

Give three examples of anti-TNF agents used in psoriatic arthritis?

A
  • Infliximab
  • Etanercept
  • Golimumab
23
Q

How do anti-TNF agents work?

A

They target specific parts of the immune system to reduce symptoms

24
Q

What is the advantage of anti-TNF agents over DMARDs?

A

They caused less collateral damage

25
Q

What is the problem with the use of anti-TNF antibodies in psoriatic arthritis?

A
  • May increase the risk of minor or serious infections
  • Can be associated with nervous system disorders, blood disorders, or certain types of cancers
26
Q

What effect does low level laser therapy have in psoriatic arthritis?

A

It can relieve pain and stiffness associated with the arthritis, as well as treating the skin component

27
Q

When might corticosteroid injections be used in psoriatic arthritis?

A

When one joint is severely affected

28
Q

What % of people with psoriatic arthritis will develop psoriatic spondylitis?

A

20%

29
Q

What is psoriatic spondylitis?

A

Spinal involvement in the disease, where inflammation of the spine leads to complete fusion.

Alternatively, it can only affect certain areas, such as the lower back or neck

30
Q

How is HLA-B27 associated with psoriatic spondylitis?

A

Patients who are HLA-B27 positive are much more likely than others to have disease that progresses to the spine

31
Q

How can psoriatic arthritis affect the eyes?

A

Psoriatic arthritis is associated with inflammatory eye conditions that cause redness, pain, blurred vision, and light sensitivity

32
Q

What % of people with psoriatic arthritis have conjunctivitis?

A

30%

33
Q

What % of people with psoriatic arthritis have iritis?

A

7%

4: Y4 - Rheumatology [19] (10 decks)

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