Psoriatic Arthritis

Question 1

What is psoriatic arthritis?

Answer 1

1. Inflammatory arthritis associated with psoriasis

Question 2

What demographic of people does PsA affect?

Answer 2

1. Men and women equally
2. MC around 40-50

Question 3

What is the clinical presentation of PsA?

Answer 3

1. Asymmetric arthritis (oligoarthritis <5 joints)
   *affects the DIP joints
   *dactylitis
2. Pitting of the nails, erythematous rash with thick, silvery white scales
3. Joint pain
4. Joint stiffness
   *am stiffness >30 mins
   *better with physical activity
5. Eye inflammation (conjunctivitis, iritis, or uveitis)

Question 4

What are the laboratory features of PsA?

Answer 4

1. Rf, ANA and anti citrullinated protein antibodies (ACPA) negative
2. Elevated ESR and CRP
3. +HLA B27
4. BUN, Creatinine, uric acid, urinalysis
5. CBC with diff (anemia; asses for chronic bleed due to the NSAIDs)

Question 5

What are the radiographic features of PsA?

Answer 5

1. Erosions and resorptions
2. Joint space narrowing
3. New bone growth at the enthesis
4. Sacroiliitis
5. Pencil in cup deformity

Question 6

What are ways the PsA could be presented?

Answer 6

1. Distal arthritis
2. Asymmetric oligoarthritis
3. Symmetric polyarthritis
4. Arthritis mutilans (which is destroying the joints)
5. Spondyloarthropathy

Question 7

What are the hallmark signs of PsA?

Answer 7

1. Dactylitis
2. Enthesitis

Question 8

What are some DD of PsA?

Answer 8

1. RA
2. Ankylosing spondylitis
3. Reactive arthritis
4. Inflammatory bowel disease
5. Gout
6. OA

Question 9

What is the CASPAR criteria for the classification of PsA? (Skin psoriasis)

Answer 9

Current/present: 2
History: 1
Family history: 1

Question 10

What is the CASPAR criteria for the classification of PsA? (Nail dystrophy)

Answer 10

Oncycholysis/pitting: 1

Question 11

What is the CASPAR criteria for the classification of PsA? (Rf)

Answer 11

Negative Rf: 1

Question 12

What is the CASPAR criteria for the classification of PsA? (Dactylitis)

Answer 12

Current/present or past OR documented by a rheumatologist: 1

Question 13

What is the CASPAR criteria for the classification of PsA? (Radiographs)

Answer 13

Evidence of juxta-articular new bone formation (spurs of new bone forming around the joint): 1

Question 14

What is the pharmacological treatment of PsA?

Answer 14

1. NSAIDs (mild disease)
2. DMARDS (>5 joints)
   *start with MTX (drug of choice), then Leflunomide or add TNF
3. Coordinate with rheumatology, PCP, derm
4. Don’t use corticosteroids (may precipitate pustular psoriasis)

Question 15

What is the non-pharmacological treatment for PsA?

Answer 15

1. Exercise
2. P/OT
3. Weight reduction