Psoriatic Arthritis Flashcards
Define psoriatic arthritis
Chronic inflammatory arthritis affecting the joints and connective tissue associated with psoriasis
Psoriatic arthritis is part of which group of conditions
Seronegative spondyloarthropathy
The psoriatic arthritis varies in severity.
How do they present
Patients may have a mild stiffening and soreness in the joint or it can be completely destroyed
Name the three conditions that are classified as seronegative spondyloarthropathy
Psoriatic arthritis
Reactive arthritis
Ankylosing spondylitis
Psoriatic arthritis does not have a single pattern of affected joints.
Name the 5 recognised patterns
“SADAS”
S - Symmetrical polyarthritis
A - Asymmetrical oligoarthritis
D - Distal interphalangeal joint arthritis
A - Arthritis mutilans
S - Spondylitis with sacroiliac and spinal involvement
What are the two most common recognised patterns for psoriatic arthritis
Symmetrical polyarthritis
Asymmetrical oligoarthritis
Describe symmetrical polyarthirits - recognised pattern for psoriatic arthritis
Inflammation > 5 joints in a symmetrical fashion
Similar presentation to rheumatoid arthritis
Which recognised pattern of psoriatic arthritis is more common in women
Symmetrical polyarthritis
Which recognised pattern of psoriatic arthritis is more common in men
Spondylitis with sacroiliac and spinal involvement
What joints are commonly affected in symmetrical polyarthritis (a recognised pattern of psoriatic arthritis)
Hands, wrists, ankles and DIP joints are affected
MCP joints are less commonly affected (unlike rheumatoid)
Describe asymmetrical oligoarthritis (recognised pattern of psoriatic arthritis)
Inflammation < 5 joints
Asymmetrical distribution of joint involvement
Describe distal interphalangeal joint arthritis (recognised pattern of psoriatic arthritis)
Characterised by distal interphalangeal (DIP) joint involvement
What is the name given to the most severe pattern of psoriatic arthritis
Arthritis mutilans
Describe arthritis mutilans (recognised pattern of psoriatic arthritis)
Severe deformity where there is destruction (osteolysis) of bone and collapse of digits
Describe spondylitis with sacroiliac and spinal involvement (recognised pattern of psoriatic arthritis)
Inflammation of the joints in the spine and atlanto-axial joint involvement
What are the two major risk factors for psoriatic arthritis
- Family history or personal history of psoriasis or psoriatic arthritis
- Gender
- Symmetrical polyarthritis is more common in females
- Spondylitis is more common in males
Name some of the clinical features of psoriatic arthritis
- Presence of psoriasis
- Prolonged morning stiffness in joints (lasting > 30 mins)
- Joint or digit swelling
- Pitting of the nails
- Onycholysis – separation of the nail from the bed
- Dactylitis – uniform swelling of an entire digit. Seen as soft tissue swelling on x-ray
- Enthesitis – inflammation of the entheses, which are the points of insertion of tendons into bone
Dactylitis is a unique feature of which arthritis
Psoriatic arthritis
Define enthesitis
Clinical feature of psoriatic arthritis
Inflammation of the entheses, which are the points of insertion of tendons into bone
How is psoriatic arthritis diagnosed
Clinical diagnosis based on history and physical examination
What two components uniquely distinguishes psoriatic arthritis from rheumatoid arthritis.
The presence of DIP joint involvement
Dactylitis (uniform swelling of an entire digit)
Define Dactylitis
Uniform swelling of an entire digit
Seen as soft tissue swelling on x-ray
What is the result of ESR and CPR in psoriatic arthritis
Will be normal
What are the x-ray features of psoriatic arthritis
Does not have a single pattern of affected joints – several recognised patterns
Erosion in the distal interphalangeal (DIP) joint
Periarticular new bone formation
Osteolysis – destruction of bone
Pencil-in-cup appearance – central erosions of the bone beside the joints (see image)
Dactylitis – uniform swelling of an entire digit. Seen as soft tissue swelling on x-ray
Pencil-in-cup appearance is an unique x-ray pattern in which arthritis
Psoriatic arthritis
Pencil-in-cup appearance is a x-ray pattern of psoriatic arthritis.
Describe this pattern
Central erosions of the bone beside the joints (see image)
How is psoriatic arthritis managed
NSAIDs e.g. ibuprofen, naproxen, diclofenac
Physiotherapy
Disease Modifying Antirheumatic Drugs (DMARDs) e.g. methotrexate
Intra-articular corticosteroid injection
What is the 2nd line therapy for managing psoriatic arthritis (if NSAIDS dont work)
Anti-TNF medications e.g. etanercept, infliximab or adalimumab
