Psoriasis & Psoratic Arthiritis 🖐

Question 1

What is psoriasis?

Answer 1

Chronic
Immune mediated disorder that results in polymeric predisposition combined with environmental triggers

Question 2

Triggers for psoriasis and PsA?

Answer 2

External: sunburn, morbilliform drug eruption, viral exanthema
Systemic: bacterial infections

HIV
Endocrine *hypocalcemia
Psychogenic stress
Drugs = lithium, IFNs , b-blockers
Alcohol, smoking, obesity

Question 3

Pathogenesis of psoriasis and psa

Answer 3

1. Stressed cells release DNA and rna
2. They interact with LL37 antimicrobial peptide = forming a compound
3. Dendritic cells report it to T cells
4. T cells become activated and differentiate into more active skin cells
5. They release pro inflammatory chemicals: TNF alpha, IL- 12, 17, 23
6. MAKES CELLS HYPERPROLIFERATE even before they are mature = thick plaque

Question 4

Clinical features of psoriasis and psa

Answer 4

Cutaneous plaque with silvery scale
-AUSPITZ SIGN = pinpoint bleeding upon scale removal.
-Nail changes = pitting, thickening, onycholysos, trachyonychia
- KOEBNER PHENOMENON = skin lesions appearing in areas of local trauma

Question 5

Do you have higher risk of comorbidities?

Answer 5

Obesity, cardiovascular disease, diabetes, hypertension, IBD and other auto immune conditions

Question 6

Psychosocial aspects of psoriasis?

Answer 6

Depression and compliance issues

Question 7

MILD TO MODERATE PSORIASIS

TREATMENTS

Answer 7

1. Topical corticosteroids and emollients
   Alternatives:
2. Vit D analogues (calcipotriol), tar and topical retinoids (tazarotene)

Question 8

Mild to moderate psoriasis
What to use on facial or intertriginius areas ?

Answer 8

Topical
Pinecrolimus

Question 9

SEVERE PSORIASIS

TREATMENT

Answer 9

1. Phototherapy

Adjuvant:
Systemic agents = retinoids, MTX, cyclosporine, bDMARD.

Question 10

CHILDREN & PREGNANCY

TREATMENT

Answer 10

Limited psoriasis = consider topical over systemic
1st line: low to med topical corticosteroid

Resistant or extensive disease =
Narrowband UVB therapy rather than systemic.

C/I = topical tazarotene, MTX qnd acitretin.

Question 11

Psoratic arthiritis

Which joints does it effect?

Answer 11

Smaller joints
Dip - distal interphalangeal joint
Pip - proximal

Question 12

What is
Oligoarticular peripheral arthiritis

Answer 12

Involves 5 joints

Question 13

Types of PSA

Answer 13

1. Distal psoriasis arthiritis
2. Spondylitis
3. Arthiritis mutilans
4. Enthesitis
5. Dactylitis

Question 14

Explain bone remodelling in PSA

Answer 14

Inflammation triggers bone cell hypertrophy.

1. Pro inflammatory chemicals = drive up activity of osteoclast.
   (Osteoclast = bone degradation)

at the same time

2. The connective tissues of ligaments triggers inflammation.
   These ligament cells proliferate at a faster rate = forcing bone cells to grow at a faster rate.

Both happening at the same time But not at the same location