Psoriatic arthritis

Question 1

What type of arthritis is psoriatic arthritis?

Answer 1

Inflammatory arthritis (associated with psoriasis)

Question 2

What is the relationship between skin psoriasis and psoriatic arthritis?

Answer 2

• 70% psoriasis precedes arthritis
• 15% arthritis precedes psoriasis
• 15% skin + joint manifestations develop simultaneously

Question 3

What is the presentation of psoriatic arthritis?

Answer 3

Pain + stiffness in joints with likely history of psoriasis
Nail changes - onycholysis, pitting, ridging
Fatigue
Enthesitis
Tenosynovitis
Dactylitis
Back pain
Uveitis

Question 4

What are the potential patterns of joint disease in psoriatic arthritis?

Answer 4

Symmetrical polyarthritis
Asymmetrical oligoarthritis
Distal interphalangeal joint disease
Spondyloarthritis
Arthritis mutilans

Question 5

What investigations are done in psoriatic arthritis?

Answer 5

Bloods: normocytic anaemia, raised CRP/ESR, HLA-B27
Imaging: Xray, MRI
Joint aspiration

Question 6

What are the xray findings in psoriatic arthritis?

Answer 6

Pencil in cup abnormality

Question 7

What are the MRI findings in psoriatic arthritis?

Answer 7

Sacroiliitis

Enthesitis

Question 8

What is the joint aspiration like in psoriatic arthritis?

Answer 8

Sterile, cloudy fluid, raised WCC

Question 9

What classification is used for psoriatic arthritis?

Answer 9

CASPAR

Question 10

What is the management of mild psoriatic arthritis?

Answer 10

PT

NSAIDs

Question 11

What is the management of mod-severe peripheral joint disease psoriatic arthritis?

Answer 11

DMARD (MTX / LEF)

Question 12

What is the treatment of severe peripheral joint disease psoriatic arthritis?

Answer 12

Biologic: anti-TNF, anti-IL-17R = Secukinumab

Question 13

What is the treatment for mod-severe spondylitis psoriatic arthritis?

Answer 13

Biologic

Question 14

Why are steroids avoided in psoriatic arthritis?

Answer 14

Due to increase risk of pustular psoriasis