Chapter 65 - Psoriatic Arthritis and Reactive Arthritis Flashcards
TABLE 65-1
The Classification Criteria for PsA (CASPAR)
ENTRY CRITERIA?
ENTRY CRITERIA: INFLAMMATORY ARTICULAR DISEASE OF THE JOINTS, SPINE, OR ENTHESES
TABLE 65-1
The Classification Criteria for PsA (CASPAR)
Point/s
Classification Criteria
1. Psoriasis (mutually exclusive categories for scoring)
- Current
- Personal history
- Family history (first- or second-degree relative)
- 2 points
- 1 point
- 1 point
TABLE 65-1
The Classification Criteria for PsA (CASPAR)
Point/s
Classification Criteria
2. Nail dystrophy typical of psoriasis (onycholysis, pitting, hyperkeratosis), must be current
1 point
TABLE 65-1
The Classification Criteria for PsA (CASPAR)
Point/s
Classification Criteria
3. Negative rheumatoid factor (any method except latex)
1 point
TABLE 65-1
The Classification Criteria for PsA (CASPAR)
Point/s
Classification Criteria
4. Dactylitis (current, or historical if recorded by a rheumatologist)
1 point
TABLE 65-1
The Classification Criteria for PsA (CASPAR)
Point/s
Classification Criteria
5. Juxtaarticular new bone formation (ill-defined ossification near joint margins excluding osteophytes) on plain hand/feet radiographs
1 point
TABLE 65-1
The Classification Criteria for PsA (CASPAR)
A classification of PsA is met if the final score is equal to or more than ___ points.
A classification of PsA is met if the final score is equal to or more than 3 points.
TABLE 65 2
Psoriatic Arthritis Phenotypes
Percent
Oligoarthritis
> 70%
TABLE 65 2
Psoriatic Arthritis Phenotypes
Percent
Polyarthritis/symmetric
15%
TABLE 65 2
Psoriatic Arthritis Phenotypes
Percent
Distal interphalangeal joint predominant
5%
TABLE 65 2
Psoriatic Arthritis Phenotypes
Percent
Spondyloarthritis
5%
TABLE 65 2
Psoriatic Arthritis Phenotypes
Percent
Arthritis mutilans
5%
TABLE 65-4
Medications
DRUG (2)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- ARTHRITIS
- Methotrexate
- Leflunomide
TABLE 65-4
Medications
DRUG (2)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- ARTHRITIS
- Sulfasalazine
- Abatacept
TABLE 65-4
Medications
DRUG (1)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- AXIAL SPONDYLOARTHRITIS
Etanercept
TABLE 65-4
Medications
DRUG (2)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- AXIAL SPONDYLOARTHRITIS
- Uveitis
- IBD
- Infliximab
- Adalimumab
TABLE 65-4
Medications
DRUG (1)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- AXIAL SPONDYLOARTHRITIS
- IBD [Crohn disease]
Certolizumab
TABLE 65-4
Medications
DRUG (1)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- AXIAL SPONDYLOARTHRITIS
- IBD [Ulcerative colitis]
Golimumab
TABLE 65-4
Medications
DRUG (2)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- Apremilast
- Ixekizumab
TABLE 65-4
Medications
DRUG (1)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- IBD [Crohn disease]
Ustekinumab
TABLE 65-4
Medications
DRUG (1)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- AXIAL SPONDYLOARTHRITIS
Secukinumab
TABLE 65-4
Medications
DRUG (1)
PSORIATIC DISEASE SPECIFIC INDICATIONS
- SKIN
- NAIL
- ARTHRITIS
- DACTYLITIS
- ENTHESITIS
- IBD [Ulcerative colitis]
Tofacitinib
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Risk of mucosal ulcerations, hepatotoxicity, teratogenic.
Liver function tests, blood counts and renal function need to be monitored
Folic acid 1 mg daily mandatory for the duration of therapy
Methotrexate
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Monitor liver function, blood counts
Reversible azoorspermia
Folic acid supplementation indicated
Sulfasalazine
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Risk of hepatotoxicity, teratogenic.
Monitor liver function, blood counts.
Long half-life, stores in adipose tissue.
Leflunomide
TABLE 65-4
Medications
DRUG (5)
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Drug induced SLE, Demyelinating disease, CHF, cancer
- Etanercept
- Infliximab
- Adalimumab
- Certolizumab
- Golimumab
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Weight loss (10%)
Depression (1%)
Apremilast
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Increased risk of eosinophilic pneumonia, cancer
Ustekinumab
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Increased risk of candidiasis, exacerbation of IBD
Secukinumab
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Increased risk of candidiasis, exacerbation of IBD, neutropenia
Ixekizumab
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Increased risk of elevated LDL and HDL (10-19%), pulmonary embolism, herpes zoster, neutropenia, lymphopenia, GI perforation, cancer
Tofacitinib
TABLE 65-4
Medications
DRUG
SIDE EFFECTS AND SPECIAL CONSIDERATIONS
Chronic obstructive pulmonary disease exacerbation, cancer
Abatacept