Psoriatic arthritis

Question 1

30 y/o woman with pain in hands and feet. What is the differential diagnosis?

Answer 1

RA, OA, psoriatic arthritis, autoimmune connective tissue disease, reactive arthritis

Question 2

What is enthesitis?

Answer 2

inflammation of entheses, the sites where tendons or ligaments insert into the bone

Question 3

What are the XR changes in PsA?

Answer 3

soft tissue swelling, erosions, periartciular new bone, osteolysis, pencil in cup

Question 4

Which is the main subtype of psoriatic arthritis?

Answer 4

assymetrical oligoarthritis/monoarthritis

Question 5

What are the risk factors for psoriatic arthritis?

Answer 5

smoking, family hx, , genetics (HLA-B27)

Question 6

How does the distribution of swollen joints in PsA compare to RA?

Answer 6

PsA- >3 joints in asymmetrical distribution, usually involving DIP. RA- symmetrical, involves MCP+PCP

Question 7

State two patterns on joint involvement in psoriatic arthritis

Answer 7

 Asymmetrical oligoarthritis: 60% (commonest)
 Distal arthritis of the DIP joints: 15% (classical)
 Symmetrical polyarthritis: 15% (like RA but c¯ DIPJs)
 Arthritis mutilans (rare, ~3%)
 Spinal (like AS)

Question 8

Describe three nail changes that arise in psoriatic arthritis

Answer 8

pitting, subungal hyperkeratosis, oncholysis

Question 9

Which deformity can be seen on XR in psoriatic arthritis?

Answer 9

pencil in cup deformity= erosion

Question 10

Two drug treatments for psoriatic arthritis?

Answer 10

NSAIDs
sulfasalazine, methotrexate, ciclosporin
anti-TNF