psoriatic arthritis Flashcards
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Features of psoriatic arthritis
Symmetric polyarthritis
tenderness in the distal and
interphalangeal joints MCP
= better with work
“Dactylitis is the swelling of an entire digit
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asymmetrical oligoarthritis
affects hands and feet
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3) sacroiliitis
4) DIP joint disease (10%)
5) arthritis mutilans (severe deformity fingers/hand, ‘telescoping fingers’)
Other signs of psoriatic arthritis ?
nail changes:
pitting
onycholysis
periarticular disease - tenosynovitis and soft tissue inflammation resulting in:
enthesitis: inflammation at the site of tendon and ligament insertion e.g. Achilles tendonitis, plantar fascitis
tenosynovitis: typically of the flexor tendons of the hands
X-ray
coexistence of erosive changes and new bone formation
periostitis
‘pencil-in-cup’ appearance
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mild peripheral arthritis/mild axial disease may be treated with ‘just’
NSAID, rather than all patients being on disease-modifying therapy as with RA
moderate/severe disease
methotrexate is typically used as in RA
if resistant to NSAIDS AND METHOTREXATE
ciclosporin
systemic retinoids
biological agents: infliximab, etanercept and adalimumab
ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials
apremilast: phosphodiesterase type-4 (PDE4) inhibitor → suppression of pro-inflammatory mediator synthesis and promotion of anti-inflammatory mediators
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oral methotrexate is used first-line
ciclosporin
systemic retinoids
biological agents: infliximab, etanercept and adalimumab
ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials
