Psoriathic Arthritis

Question 1

What is psoriatic arthritis?

Answer 1

• Infalmmatory arthritis associated c psoriasis

Question 2

What percentage of psoriatic patients develop PA?

Answer 2

• 10

Question 3

What are the examples of seronegative spondyloarthropathy?

Answer 3

• Psoriatic arthritis
• Ankylosing spondylitis
• Reactive arthritis
• IBD associated

Question 4

What are the Sx for PA?

Answer 4

*no single pattern

• Symmetrical polyarthritis
  
  • common in women
  • hands,wrist, ankles, DIP affected
  • MCP less affected
• Asymmetrical pauciarthritis
  
  • digits and feet
• Spondylitic pattern
  
  • common in men
  • Back stiffness, sacroilitis
• Others
  
  • achilles tendon
  • spine
    *

Question 5

What are the extra articular manifestation of PA?

Answer 5

• plaques - can occur after joint sx
• pittig of nails
• onchylosis
• dactylitis (inflammation of full finger)
• enthesitis
• conjucntivitis, uveitis
• aortitis
• amyloidosis

Question 6

What tool can be used to screen PA?

Answer 6

• Psoriasis Epidemiological Screening Tool (PEST)
  
  • Ask about
    
    • joint pain
    • swelling
    • arthritis
    • nail pitting

Question 7

What ix would you order for PA?

Answer 7

• Bloods - exclude RA
• Xray

Question 8

What are the changes seen on xray for PA?

Answer 8

• Pencil-cup appearance
• Periostitis
• Ankylosis
• Osteolysis
• Dact

Question 9

What is the most severe form of PA called?

Answer 9

Arthritis Mutilans

Question 10

What is the Px of Arthritis Mutilans?

Answer 10

1. Osteolysis of bones around digit joints
2. Progressive shortening of digit
3. Skin folds as digit shortens - telescopic finger

Question 11

What is the Mx for PA?

Answer 11

• NSAIDs
• DMARDs
• Anti TNF
• Ustekinumab (last line)

Question 12

What does seronegative mean?

Answer 12

• a person test negative for RF and cyclic citrullinated peptide (CCP)

Question 13

What are the RF of PA?

Answer 13

• psoriasis
• FHx
• Age - typically 30-50
• geetic markers
• viral/bacterial infection