Psoriatic Arthritis

Question 1

What are the different patterns of joints affected in psoriatic arthritis?

Answer 1

Symmetrical polyarthritis = most common in F
-similar presentation as RA but MCP less commonly affected

Asymmetrical pauciarthritis
-mainly digits affected and only a few joints

Spondylitic= most common in M
-back stiffness
-sacroiliitis
Atlanto-axial joint involvement

Distal interphalangeal joint arthritis

Arthritis mutilans (RARE)
-telescoping of digits due to joint destruction

Question 2

What are the common signs associated with psoaritic arthritis?

Answer 2

Inflammatory arthritis of DIP
Assymetrical arthritis 
Sacroiliitis (asymptomatic)
Plaques of psoriasis on skin 
Pitting of nails 
Onycholysis= seperation of nail from nail bed 
Dactylitis= inflammation of full finger (esp associated in psoriatic arthritis)
Conjunctivitis 
Anterior uveitis 
Aortitis 
Amyloidosis
50% have enthesitis + axial disease

Question 3

What are the classic X-ray changes associated with psoaritic arthritis?

Answer 3

Periostitis = inflammation of periosteum i.e. outline of bones appears thick

Ankylosis= bones joint together

Osteolysis= destruction of bone

Dactylitis= appears as soft tissue swelling

Pencil-in-cup appearance= occurs in digits where central erosion of bone in joint causes one bone to appear as cup-shape and another as narrow “pencil” siting in cup

Question 4

How is psoaritic arthritis managed?

Answer 4

NON-PHARMA:

• physio
• OT
• hydrotherapy
• orthotist

PHARMA:
NSAIDs
DMARDs
-methotrexate
-leflunomide 
-CY A
Anti-TNF (infliximab)
Corticosteroids

Question 5

What can happen when weaning off corticosteroids?

Answer 5

Can get rebound flare of skin disease as steroids wear off