Psoriatic Arhritis, Reactive Arthritis Flashcards
What is psoriatic arthritis?
An inflammatory arthritis associated with psoriasis (10-20%)
part of seronegative spondyloarthropathy group of conditions
can vary in severity
Who does psoriatic arthritis tend to affect?
middle age, but can occur at any age
What are the different patterns of psoriatic arthritis?
Symmetrical polyarthritis (rheumatoid like, 30-40% most common)
Asymmetrical oligoarthritis
Spinal/Sacroilitis
DIP joint disease (10%)
Arthritis mutilans (severe deformity of fingrs/hands, telescoping)
How does symmetrical polyarthritis present?
similarly to rheumatoid arthritis
hands, wrists, ankles and DIP joints affected (MCP less affected unlike rheumatoid)
more common in women
How does asymmetrical oligoarthritis present?
affects mainly digits - hands and feet
How does sacroilitis present in psoriatic arthritis?
back stiffness
sacroilitis
atlatl-axial joint involvement
What are the signs of psoriatic arthritis ?
plaques of psoriasis on the skin
pitting of the nails
Oncholysis (separation of the nail from nail bed)
Dactylitis (inflammation of full finger)
Enthesitis (inflammation of the entheses )
What tool can you use to screen for psoriasitic arthritis?
PEST (psoriasis epidemiological screening tool)
What are x-ray changes seen in psoriatic arthritis?
- Erosive changes with Pencil in cup appearance - end of bone has eroded into sharp pencil shape which has worn away surface of an adjoining bone into cup shape.
seen in severe disease such as arthritis mutilans
- periostitis - inflammation of periosteum leading to thickened and irregular outline of bone
What is arthritis mutilans?
most severe form
telescoping of nails occurs due to osteolysis (destruction) of the bones around the joints leading to progressive shortening of the digits
How do you manage psoriatic arthritis?
refer to rheumatology
treat as rheumatoid arthritis but better prognosis
- NSAIDs for pain
- DMARDs - methotrexate, sulfasalazine
- Anti-TNF - etanercept, adalmumab
- Monolocal antibody USTEKINUMAB is last line
what is reactive arthritis?
another of the HLA-B27 associated seronegative spondyloarthropathies
where synovitis occurs in joints in reaction to a recent infective trigger leading to a monoarthritis generally
it is associated with Reiter’s syndrome
What is Reiter’s syndrome?
triad of - can’t see, can’t pee, can’t climb a tree
- bilateral conjunctivitis, anterior uveitis
- arthritis
- urethritis, circinate balanitis
what is the main differential for reactive arthritis?
septic arthritis - but no infection in RA
what are the two common categories of infections which cause Reactive arthritis?
Which pathogens cause?
post-dysenteric shigella flexneri salmonella Yersinia campylobacter
post-STI
chlamydia trachomatis
