Inflammatory Spondyloarthropathy - Psoriatic Arthritis

Question 1

What is Psoriatic Arthritis?

Answer 1

An inflammatory arthritis associated with Psoriasis.

Question 2

Patterns of Presentation of Disease (3).

Answer 2

1. Symmetrical like RA (Commoner in Women) - affecting Hands, Wrists, Ankles, DIPs but not MCP (unlike Rheumatoid).
2. Asymmetrical Oligoarthritis (digits).
3. Spondylitis (Commoner in Men).

Question 3

Clinical Features of Psoriatic Arthritis (6).

Answer 3

1. Psoriatic Plaques.
2. Pitting of Nails.
3. Onycholysis (Separation of Nail from Nailbed).
4. Dactylitis.
5. Enthesitis.
6. Subungual Hyperkeratosis.

Question 4

Skin Changes in Psoriatic Arthritis.

Answer 4

Arthritis precedes development of skin lesions.

Question 5

X-Ray Changes of Psoriatic Arthritis (5).

Answer 5

1. Periostitis (Thickened, Irregular Outline of Bone).
2. Ankylosis (Fusion).
3. Osteolysis.
4. Dactylitis.
5. Pencil-in-Cup (central erosions).

Question 6

Screening Tool in Psoriatic Arthritis.

Answer 6

PEST : Psoriasis Epidemiological Screening Tool - refer to Rheumatology if high score.

Question 7

Management of Psoriatic Arthritis (4).

Answer 7

Similar to Rheumatoid Arthritis :

1. NSAIDs for Pain.
2. DMARDs (Methotrexate, Leflunomide, Sulfasalazine).
3. Anti-TNF Medications.
4. Last Line : Ustekinumab.

Question 8

What is Ustekinumab?

Answer 8

A monoclonal antibody targeting IL-12 and IL-13.

Question 9

What is Arthritis Mutilans?

Answer 9

Most severe form, occurring in the phalanges with osteolysis and shortening of the digit - telescopic finger (skin changes).

Question 10

Prognosis of Psoriatic Arthritis.

Answer 10

Big Variation : Mild Stiffening or Soreness in Joint OR Arthritis Multilans (Complete Destruction).