Psoriatic arthritis

Question 1

Psoriasis is a chronic inflammatory skin disease. What is the world wide prevalence of psoriasis?

1 - 1-3%
2 - 10-13%
3 - 20-30%
4 - 30-40%

Answer 1

1 - 1-3%
- in the UK this is 2.8%

Question 2

Psoriasis has a bimodal peak in age, with type 1 occurring <40 = early onset and type 2 = late onset occurring >40 years. Is this more common in men or women?

Answer 2

• equal in both

Psoriatic arthritis typically affects both just as much

Question 3

What % of patients with psoriasis have some form of family history of Psoriasis?

1 - 6-9%
2 - 16-19%
3 - 46-49%
4 - 60-90%

Answer 3

4 - 60-90%

Question 4

What age is psoriatic arthritis (PA) typically diagnosed?

1 - 20-30
2 - 30-50
3 - 40-60
4- >75

Answer 4

2 - 30-50

Question 5

How many people with psoriasis develop psoriatic arthritis?

1 - 1 in 2
2 - 1 in 3
3 - 1 in 6
4 - 1 in 10

Answer 5

2 - 1 in 3
- patients have psoriasis for 10 years before developing psoriatic arthritis

Question 6

Psoriatic arthritis (PA) is an inflammatory joint problem that occurs in patients with psoriasis. PA are seronegative spondyloarthropathies, which are autoimmune diseases that affect the joints. Does this mean they do or do NOT have specific antibodies associated with them?

Answer 6

• No specific antibodies associated with it
• negative for RF commonly seen in RA

Other examples include:
- ankylosing spondylitis
- inflammatory bowel disease (IBD) associated arthritis
- reactive arthritis

Question 7

Although the cause of Psoriasis is likely to be multifactorial, one theory is that the skin can become irritated by environmental or microorganisms that act as a trigger. This trigger causes which cell to then initiate an immune response?

1 - neutrophils
2 - macrophages
3 - dendritic cells
4 - eosinophils

Answer 7

3 - dendritic cells

Question 8

Once the dendritic cells in the skin have been triggered they will elicit an immune response by activating T cells that release cytokines and cause inflammation. What then happens to the keratinocyte in the area?

1 - cells in the area die due to inflammation
2 - tissue scars causing abscess formation
3 - keratinocyte proliferation
4 - all of the above

Answer 8

3 - keratinocyte proliferation
- this is what causes plaques on the skin

• typically once the trigger is removed the inflammation subsides, BUT in Psoriasis, this inflammation becomes chronic

Question 9

Which of the following can be used to describe the most common clinical feature in a caucasian with Psoriasis?

1 - plaques
2 - pink or red underlying skin
3 - white scaly appearance on top
4 - rough to touch
5 - all of the above

Answer 9

5 - all of the above
8-9 / 10 will have these forms of plaques if they have Psoriasis
- typically can be very itchy

Question 10

Where are plaques most commonly found on the body?

1 - face and head
2 - torso and extensor surface of limbs
3 - all over limbs
4 - torso only

Answer 10

2 - torso and extensor surface of limbs

Question 11

Are the plaques that are the most common feature of psoriases as evident in pigmented skin?

Answer 11

• no
• it is more difficult to identify the erythema

Question 12

Are psoriatic plaques present in the flexor regions of joints?

Answer 12

• typically no

Question 13

Which human leukocyte antigen (HLA) is commonly associated with seronegative spondyloarthropathies such as psoriatic arthritis (PA)?

1 - HLA-B27
2 - HLA-DR2
3 - HLA-DQ3
4 - HLA-DR3

Answer 13

1 - HLA-B27
- self antigens against this HLA attack the joints

Question 14

The pathogenesis of psoriatic arthritis (PA) is multifactorial. Which 2 of the following have been linked with PA?

1 - Environmental factors
2 - Infection strep, HIV
3 - Drugs
4 - Obesity

Answer 14

1 - Environmental factors
2 - Infection strep, HIV

Question 15

In psoriatic arthritis (PA) the immune cells can attack the joints, activating what that can cause joint erosion and ossification?

1 - fibroblasts
2 - osteocytes
3 - osteoblasts
4 - osteoclasts

Answer 15

3 - osteoblasts
4 - osteoclasts

Question 16

Does psoriatic arthritis (PA) just have acute flairs or is it chronic and progressive?

Answer 16

• chronic and progressive

Question 17

Which of the following is NOT a typical symptom of psoriatic arthritis (PA)?

1 - cold and clammy joints
2 - painful
3 - swollen
4 - stiff

Answer 17

1 - cold and clammy joints
- inflammatory so joints are hot, red and swollen

Question 18

Does oligoarthritis or polyarthritis affect more joints?

Answer 18

• polyarthritis
  Typically affects >5 or more

Oligoarthritis typically affects <5

Question 19

There are 5 types of psoriatic arthritis (PA), which one of the following is NOT a type of PA?

1 - oligoarticular
2 - polyarticular or rheumatoid pattern
3 - reactive arthritis
4 - spondyloarthritis
5 - distal interphalangeal predominant
6 - arthritis mutilans

Answer 19

3 - reactive arthritis

Question 20

All of the following are types of psoriatic arthritis (PA). Which of the following is the most common form of PA?

1 - oligoarticular
2 - polyarticular or rheumatoid pattern
3 - spondyloarthritis
4 - distal interphalangeal predominant
5 - arthritis mutilans

Answer 20

1 - oligoarticular
- up to 50% of cases are oligoarticular

Question 21

Oligoarticular is the most common form of psoriatic arthritis (PA) affecting <5 joints. Is the joint pattern affected symmetrical (affecting the same joints on both sides of the body) or asymmetrical?

Answer 21

• asymmetrical

Question 22

In psoriatic arthritis (PA) which joints are affected?

1 - any joints including the distal interphalangeal joint (DIP)
2 - knees, hips and spine
3 - metacarpophalangeal (MCP) joints and the proximal interphalangeal (PIP)
4 - all joints in the body except for distal interphalangeal joint (DIP)

Answer 22

1 - any joints including the distal interphalangeal joint (DIP)

In RA the DIP are spared, this is how we can tell the difference

Question 23

Which of the following typically occurs in psoriatic arthritis (PA) but NOT in RA?

1 - dactylitis (sausage finger)
2 - enthesitis (tendon inflammation) (achilles tendon and plantar fasciitis)
3 - skin and nail involvement
4 - seronegative
5 - periostreal new bone formation and hook osteophytes on imaging
6 - all of the above

Answer 23

6 - all of the above

Question 24

Which of the following GIT conditions is x 1-4 times more likely in patients with psoriatic arthritis?

1 - IBS
2 - IBD
3 - coeliac disease
4 - GORD

Answer 24

2 - IBD

Question 25

The psoriatic arthritis (PA) response criteria is used to identify the disease severity in patients with psoriatic arthritis. What is typically the first line treatment for patients with PA?

1 - DMARDs
2 - NSAIDs
3 - Biologics
4 - NSAIDs with DMARDs

Answer 25

2 - NSAIDs

Question 26

The psoriatic arthritis (PA) response criteria is used to identify the disease severity in patients with psoriatic arthritis. What is typically the 2nd line treatment for patients with PA?

1 - DMARDs
2 - NSAIDs
3 - Biologics
4 - NSAIDs with DMARDs

Answer 26

4 - NSAIDs with DMARDs

Question 27

DMARDs are used in patients with more severe cases of psoriatic arthritis (PA). Which 2 of the following are the 2 commonly used DMARDs?

1 - Methotrexate
2 - Infliximab
3 - Sulfasalazine
4 - Adalimumab

Answer 27

1 - Methotrexate
3 - Sulfasalazine

Infliximab and Adalimumab
- inhibit TNF-a inhibitors