Psoriatic Arthritis

Question 1

Define psoriatic arthritis

Answer 1

Chronic inflammatory arthritis affecting the joints and connective tissue associated with psoriasis

Question 2

Psoriatic arthritis is part of which group of conditions

Answer 2

Seronegative spondyloarthropathy

Question 3

The psoriatic arthritis varies in severity.

How do they present

Answer 3

Patients may have a mild stiffening and soreness in the joint or it can be completely destroyed

Question 4

Name the three conditions that are classified as seronegative spondyloarthropathy

Answer 4

Psoriatic arthritis

Reactive arthritis

Ankylosing spondylitis

Question 5

Psoriatic arthritis does not have a single pattern of affected joints.

Name the 5 recognised patterns

Answer 5

“SADAS”

S - Symmetrical polyarthritis

A - Asymmetrical oligoarthritis

D - Distal interphalangeal joint arthritis

A - Arthritis mutilans

S - Spondylitis with sacroiliac and spinal involvement

Question 6

What are the two most common recognised patterns for psoriatic arthritis

Answer 6

Symmetrical polyarthritis

Asymmetrical oligoarthritis

Question 7

Describe symmetrical polyarthirits - recognised pattern for psoriatic arthritis

Answer 7

Inflammation > 5 joints in a symmetrical fashion

Similar presentation to rheumatoid arthritis

Question 8

Which recognised pattern of psoriatic arthritis is more common in women

Answer 8

Symmetrical polyarthritis

Question 9

Which recognised pattern of psoriatic arthritis is more common in men

Answer 9

Spondylitis with sacroiliac and spinal involvement

Question 10

What joints are commonly affected in symmetrical polyarthritis (a recognised pattern of psoriatic arthritis)

Answer 10

Hands, wrists, ankles and DIP joints are affected

MCP joints are less commonly affected (unlike rheumatoid)

Question 11

Describe asymmetrical oligoarthritis (recognised pattern of psoriatic arthritis)

Answer 11

Inflammation < 5 joints

Asymmetrical distribution of joint involvement

Question 12

Describe distal interphalangeal joint arthritis (recognised pattern of psoriatic arthritis)

Answer 12

Characterised by distal interphalangeal (DIP) joint involvement

Question 13

What is the name given to the most severe pattern of psoriatic arthritis

Answer 13

Arthritis mutilans

Question 14

Describe arthritis mutilans (recognised pattern of psoriatic arthritis)

Answer 14

Severe deformity where there is destruction (osteolysis) of bone and collapse of digits

Question 15

Describe spondylitis with sacroiliac and spinal involvement (recognised pattern of psoriatic arthritis)

Answer 15

Inflammation of the joints in the spine and atlanto-axial joint involvement

Question 16

What are the two major risk factors for psoriatic arthritis

Answer 16

• Family history or personal history of psoriasis or psoriatic arthritis
• Gender
  
  • Symmetrical polyarthritis is more common in females
  • Spondylitis is more common in males

Question 17

Name some of the clinical features of psoriatic arthritis

Answer 17

• 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

Question 18

Dactylitis is a unique feature of which arthritis

Answer 18

Psoriatic arthritis

Question 19

Define enthesitis

Answer 19

Clinical feature of psoriatic arthritis

Inflammation of the entheses, which are the points of insertion of tendons into bone

Question 20

How is psoriatic arthritis diagnosed

Answer 20

Clinical diagnosis based on history and physical examination

Question 21

What two components uniquely distinguishes psoriatic arthritis from rheumatoid arthritis.

Answer 21

The presence of DIP joint involvement

Dactylitis (uniform swelling of an entire digit)

Question 22

Define Dactylitis

Answer 22

Uniform swelling of an entire digit

Seen as soft tissue swelling on x-ray

Question 23

What is the result of ESR and CPR in psoriatic arthritis

Answer 23

Will be normal

Question 24

What are the x-ray features of psoriatic arthritis

Answer 24

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

Question 25

Pencil-in-cup appearance is an unique x-ray pattern in which arthritis

Answer 25

Psoriatic arthritis

Question 26

Pencil-in-cup appearance is a x-ray pattern of psoriatic arthritis.

Describe this pattern

Answer 26

Central erosions of the bone beside the joints (see image)

Question 27

How is psoriatic arthritis managed

Answer 27

NSAIDs e.g. ibuprofen, naproxen, diclofenac

Physiotherapy

Disease Modifying Antirheumatic Drugs (DMARDs) e.g. methotrexate

Intra-articular corticosteroid injection

Question 28

What is the 2nd line therapy for managing psoriatic arthritis (if NSAIDS dont work)

Answer 28

Anti-TNF medications e.g. etanercept, infliximab or adalimumab