Psoriatic Arthritis

Question 1

what signs might you see in the nails for psoriatic arthritis ?

Answer 1

• Nail pitting
• Onycholysis
• Dactylitis
• Enthesitis

Question 2

what are other associations of psoriatic arthritis ?

Answer 2

1) Eye disease  conjunctivitis, anterior uveitis
2) Aortitis
3) Amyloidosis

Question 3

what x-ray changes can you see in psoriatic arthritis?

Answer 3

1) Periostitis – inflammation of the periosteum leading to a thickened outline of the bone.
2) Ankylosis – bones fuse causing stiffening.
3) Osteolysis – destruction of bone
4) Dactylitis – inflammation of the digit (shows on x-ray as soft tissue swelling)
5) Pencil in cup appearance

Question 4

what are the signs and symptoms do we see in arthritis mutilans?

Answer 4

• Most severe form of psoriatic arthritis which occurs at the phalanxes.
• There is osteolysis of the bones around the joints in digits leading to the digit shortening.
• The skin then folds giving a ‘telescopic’ appearance.

Question 5

how do you manage psoriatic arthritis?

Answer 5

• NSAIDs for pain
• DMARDs (methotrexate, leflunomide, sulfasalazine)
• Anti-TNF (etanercept, infliximab, adalimumab)
• Ustekinumab is last line (monoclonal antibody targeting IL12 and IL23)

Question 6

what are the types of psoriatic arthritis ?

Answer 6

1) Symmetrical polyarthritis – like RA and is more common in women, usually the hands, wrists, ankles and DIPs
2) Asymmetrical pauciarthritis – usually the digits and only a few joints.
3) Spondylitic pattern – more common in men, back stiffness, sacroiliitis, antlanto-axial joint
4) Other areas to consider  spine, achilles tendon, plantar fascia

Question 7

what is psoriatic arthritis classified as?

Answer 7

• It is part of the ‘seronegative spondyloarthropathies’.