Psoriasis/Psoriatic Arthritis Flashcards
This type of psoriasis is characterized by small (3-5 millimeters) confetti-like, salmon pink, papules with fine scaling. It is most likely to affect the trunk and proximal extremities and often appears suddenly (as an initial manifestation of psoriasis in younger patients) and is often preceded by a strep upper respiratory infection.
Guttate Psoriasis
This type of psoriasis is associated with lesions that occur in skin folds (armpits, abdominal, genital, inframammary areas). Due to local moisture, lesions tend to be less scaly and more erythematous and genital involvement is observed in up to 1/3 of patients with psoriasis.
Inverse Psoriasis
This type of psoriasis is characterized by white blisters of noninfectious pus surrounded by red skin and may be localized to areas such as palms or sole of feet.
Pustular Psoriasis
This is a severe form of pustular psoriasis associated with covering most of the body and fever, chills, severe itching, change in heart rate, fatigue, and muscle weakness.
von Zumbusch variant
This type of psoriasis is characterized by generalized erythema, scales, or exfoliation that covers at least 75% of the body. The skin cannot properly maintain temperature, leading to: hypothermia, chills, dehydration from fluid loss, fever, malaise, swelling in the lower legs, congestive heart failure.
Erythrodermic Psoriasis
Mild psoriasis is considered to be what % of BSA?
<3%
Moderate psoriasis is considered to be what % of BSA?
3-10%
Severe psoriasis is considered to be what % of BSA?
> 10%
What does PASI stand for?
Psoriasis Area and Severity Index
What does PGA stand for?
Physician’s Global Assessment
What does NAPSI stand for?
Nail Psoriasis Severity Index
What does DLQI stand for?
Dermatology Life Quality Index
25% of patients with PsA are HLA-B__ positive
HLA-B27
CD__+ cells predominate in psoriatic joints
4
In PsA, the most notable contributing Th subsets are?
Th1 & Th17 cells
These cells play a central role in PsA pathogenesis?
CD8+ cells
ESR is a measure of inflammation that can be used in the diagnosis of PsA when elevated. What does ESR stand for?
Erythrocyte sedimentation rate
CRP can be elevated in PsA and is a marker of inflammation. What does CRP stand for?
C-reactive protein
What are joint erosions in PsA?
Bony destruction that occurs at the outer borders of a joint space in inflammatory arthritis. It is visible on radiographic images of joints.
What is joint space narrowing?
The radiographic appearance of a joint that has lost its surface cartilage. The bones in the joint are not separated by the normal of usually observed distance. They appear to be too close to each other, and they are often eburnated or sclerotic.
What is a bony proliferation?
Rapid and repeated reproduction of new bone cells. In radiographic results, bones appear irregular and “fuzzy” around the affected joint.
Osteolysis
Softening, absorption, and destruction of bony tissue, a function of the osteoclasts.
Pencil-in-cup deformity
A form of osteolysis found in severe inflammatory arthritis, especially in the finger and toe joints. The deformity is characterized by thinning of the phalangeal shaft and widening of its base proximal to the joint space.
Acroosteolysis
Congenital condition manifested by palmar and plantar ulcerating lesions with osteolysis involving distal phalanges of the fingers and toes.
Ankylosis
The abnormal union of the bones to a joint.
Spur formation
A bony growth that arises from the surface of a bone, often involving the ossification of muscular attachments; also called exostosis.
Spondylitis
Inflammation of one or more vertebrae.
CASPAR stands for…
Classification Criteria for Psoriatic Arthritis
The _____ criteria define psoriatic arthritis for the purpose of enrolling patients in clinical trials and providing guidance to the clinicians.
CASPAR
HAQ-DI
Health Assessment Questionnaire- Disability Index
HAQ-DI is considered a _____ status assessment
Functional
SF-36
Short Form 36 Health Survey
Higher scores on the SF-36 = better health. True or False?
True
ACR20
American College of Rheumatology 20
The ACR20 requires at least a ___% improvement in the core set measures.
20
PASDAS
Psoriatic Arthritis Disease Activity Score
This measure is a composite-weighted index including assessment of joints, entheses, dactylitis, the patient’s and physician’s global health scores, and the SF-36.
PASDAS
DAPSA
Disease Activity Index for Psoriatic Arthritis
This composite measure is based on the sum of the number of 68 tender and 66 swollen joints, the patient’s global assessment of disease activity and pain, and serum levels of C-reactive protein. It does not assess other aspects of PsA.
DAPSA
CPDAI
Composite Psoriatic Disease Activity
In this index, disease activity is assessed as absent, mild, moderate, or severe in five PsA domains (peripheral arthritis, skin and nails, axial arthritis, enthesitis, dactylitis). Treatment is based on the most active domain while considering disease activity in the others.
CPDAI
GRACE
GRAPPA Composite Exercise
This is a composite-weighted index that includes assessment of disease activity in the joints, patient and physician global health scores, quality of life, and psoriasis area severity index (PASI).
GRACE
DMARD
Disease Modifying Antirheumatic Drugs
Methotrexate, Sulfasalazine, and Leflunomide are examples of __________ DMARDs.
Conventional (non-specific)
Cimzia (PsA tx) generic name
Certolizumab pegol
Cimzia target
TNF alpha
Cosentyx generic name
Secukinumab
Secukinumab target
IL-17A
Enbrel (PsA tx) generic name
Etanercept
Etanercept target(s)
TNF alpha and TNF beta
Humira generic name
Adalimumab
Humira target
TNF alpha
Orencia generic name
Abatacept
Abatacept target
T cell (binds CD80 and CD86)
Otezla generic name
Apremilast
Apremilast target
PDE4 (Phosphodiesterase 4 inhibitor)
Infliximab brand name
Remicade
Infliximab target
TNF alpha
Golimumab brand name
Simponi/Simponi Aria
Simponi target
TNF alpha
Stelara generic name
Ustekinumab
Ustekinumab target
IL-12/IL-23
Stelara binds to the p__ subunit of IL-12 and IL-23
p40
Ixekizumab brand name
Taltz
Ixekizumab target
IL-17A
Xeljanz generic name
Tofacitinib
Tofacitinib target
JAK (small molecule JAK inhibitor)
JAK stands for….
Janus Kinase
What are the 3 PsA guidelines?
GRAPPA, EULAR, ACR/NPF
GRAPPA (guidelines) stands for?
Group for Research and Assessment of Psoriasis and Psoriatic Arthritis
EULAR (guidelines) stand for?
European League Against Rheumatism
ACR/NPF (guidelines) stand for?
American College of Rheumatology/National Psoriasis Foundation
IGA stands for…
Investigator Global Assessment
IGA assesses/measures 3 components, what are they?
Hint: I,E,S
Induration, Erythema, Scaling
PASI stands for…
Psoriasis Area and Severity Index
Unlike the IGA score, PASI takes into account the…
Body Surface Area or Area of Involvement
ss-IGA stands for…
Scalp Specific Investigator’s Global Assessment
NAPSI stands for…
Nail Psoriasis Severity Index
IGA scores range from…
0-4 (with 4 being the most severe and 0 being clear)
PASI scores range from…
0-72 (with higher scores indicating more severity)
PGA stands for…
Fingernail Physician’s Global Assessment
hf-PGA stands for…
Physician’s Global Assessment of Hands and/or Feet
DLQI is a PRO that stands for…
Dermatology Life Quality Index
PSSD is a PRO that stands for…
Psoriasis Symptom and Sign Diary
What is onycholysis?
Separation of nail from underlying nail bed
What is leukonychia?
White spots or streaks on nail
This is the most common clinical sign of nail psoriasis and can be seen on the nail of digits affected by dactylitis.
Pitting
These are locations where the tendon, ligament, or joint capsule inserts into the bone to facilitate joint motion.
Entheses
Inflammation at the entheses is called ____.
Enthesitis
True or False: with dactylitis the hands are most commonly affected.
False, the feet are most commonly affected.
This criteria is the most used classification tool in PsA trials and has 99% specificity.
CASPAR criteria (Classification Criteria for Psoriatic Arthritis)
This is the most used PsA clinical assessment tool.
ACR (either 20/50/70)
ACR stands for?
American College of Rheumatology
Which 2 variables must show improvement when looking at ACR response?
Swollen joint counts (SJC) and Tender joint count (TJC)
What are two common assessment tools for axial involvement in PsA?
BASDAI & ASDAS
The higher the BASDAI (PRO) score, the _____ (more or less) the patient’s disability.
more
The IGA which stands for ___ assesses a patient’s psoriasis by grading psoriasis lesions for what (hint: 3 components)?
Induration, erythema, and scaling
A PASI score greater than what represents severe disease?
10
FACIT - F stands for?
Functional Assessment of Chronic Illness Therapy - Fatigue
Higher scores on the FACIT-F represent ____ (more or less?) fatigue.
Less
The most commonly used radiographic assessment tool in PsA (used to assess joint damage) is?
PsA-modified vdH-Sharp score
The Sharp/van der Heijde method is a radiographic assessment in PsA clinical trials, true of false?
True
The modified vdH-Sharp score includes assessment of what?
DIP joints
What is considered a IGA response?
IGA psoriasis score of 0 or 1 AND greater than or equal to 2 grade-reduction from baseline in the IGA psoriasis score.
This is the only enthesitis measure developed specifically for PsA?
Leeds Enthesitis Index of LEI
