Psoriatic Arthritis

Question 1

what is psoriatic arthritis?

Answer 1

an inflammatory arthritis
associated with psoriasis

part of the seronegative spondyloarthropathies

occurs in 10-20% of patients with psoriasis and usually occurs in 10 years of developing the skin changes.

Question 2

symptoms of psoriatic arhritis

Answer 2

inflammatory arthritis- stiffening and soreness of the joints or joint can be completely destroyed (arthritis mutilans)

Question 3

what are the psoriatic patterns

Answer 3

can be symmetrical
(similar to RA)
hands, wrist, ankles, DIP

asymmetrical
- mainly affect the digits (fingers and toes, feet)

pauciarthritis
arthritis that only effects a few joints.

spondylitis pattern
(common in men)
back stiffness, sacrolitis, atlanto-axial joint involvement

spine, Achilles tendon, plantar fascia

Question 4

signs of psoriatic arthritis

Answer 4

Plaques of psoriasis on the skin

Pitting of the nails

Onycholysis (separation of the nail from the nail bed)

Dactylitis (inflammation of the full finger)

Enthesitis (inflammation of the entheses, which are the points of insertion of tendons into bone)

Eye disease (conjunctivitis and anterior uveitis)
Aortitis (inflammation of the aorta)
Amyloidosis

Question 5

psoriasis epidemiological screening tool (PEST)

Answer 5

ask about joint pain, swelling, history of arthritis, nail pitting

Question 6

Xray changes on

Answer 6

periostitis- inflammation of the peritoneum (thickened and irregular outline of bone)
ankylosis (bones join together and cause stiffening)
osteolysis (destruction of the bone)
dactylics (inflammation of the whole digit, soft tissue swelling)
pencil in cup appearance
**this is central erosion of the bone beside the joint

Question 7

where is psoriasis most commonly effected

Answer 7

knees / legs
soles of feet
scalp
sacrum

Question 8

what is arthritis mutilans?

Answer 8

the most severe form of psoriatic arthritis
occurs in the palanxes
osteolysis (destruction) of the bones around the joints and digitis
progressive shortening of the digits and then the skin folds as the digit shortens which gives an appearance called ‘telescopic finger’

Question 9

what is the management for psoratic arthritis?

Answer 9

similar to RA
co-ordinated with rheumatologist and dermatologist

medical:
NSAIDs
DMART (methotrexate, leflunoamide, sulfasalazine)
anti TNF meds 
ustekinumab is last line