PsA

Question 1

Name the five (5) clinical variants of Psoriatic arthritis (PsA). In each case, describe the number and type of joints typically affected in each variant

Answer 1

Peripheral Type: most common
o DIPS affected
• Predominantly affects M

Peripheral Symmetric:
• ‘relatively’ symmetric, but more symmetry than other types of PA
• ankylosis of DIPs and PIPs
• hands, wrists, ankles, feet
• NB. important to differentiate from RA!!

Monoarticular /
Asymetrical: Hands & feet (+/- dactylitis)
• hands and feet affected first -> PIPs / DIPs / MCPs
• generally mild, slow progression

Sacrolitis / Spondylitis: axial skeleton affected

Arthritis Mutilians (5% Pts)
•	very destructive

Question 2

Describe the typical pathological processes seen in the joints affected by PsA.

Answer 2

• Processes / changes are similar to RA ie

o chronic synovitis
o Lymphocyte infiltration
o exudation
o fibrosis
o severe destruction of cartilage and bone (arthritis mutilans)
o no rheumatoid nodules
o 30% of patients have spine and sacroiliac changes similar to ankylosing spondylitis

Question 3

Describe the typical presentation of PsA.

Answer 3

• Morning stiffness
• Fatugue
• Hx of psoriatic skin lesions (mid-late 20s as initial onset)
• Nail defects
• Dactylitis (sausage fingers / toes)
• Redness / pain in eye (anterior uveitis / conjunctivitis)
• usually affects some of IP joints of the fingers/toes
• asymmetrical polyarthritis
• slow progression → may become quiescent

Question 4

What is the temporal relationship between psoriasis and PsA?

Answer 4

a. skin lesions/manifestations usually precede arthritic manifestations (85% of cases)
b. skin lesions may not be active even though the arthritis is
c. skin lesions may be difficult to see

NB. 30% of patients have ocular inflammation (anterior uveitis)