psoriatic arthritis

Question 1

define psoriatic arthritis

Answer 1

An inflammatory arthritis that is associated with psoriasis, varying in severity from mild stiffening to joint destruction.

Question 2

how many patients with psoriasis get psoriatic arthritis

Answer 2

around 10%

usually within 10 years of developing the skin condition.

Question 3

does arthritis come first or psoriasis?

Answer 3

The arthritis symptoms can occur before the rash, however, usually, the rash presents first.

Question 4

what age most commonly get psoriatic arthritis

Answer 4

middle-aged individuals

Question 5

what are the 5 recognised patterns of psoriatic arthritis

Answer 5

1. Asymmetrical oligoarthritis
2. Symmetrical polyarthritis
3. Distal interphalangeal predominant pattern
4. Spondylitis
5. Arthritis mutilans

Question 6

what is asymmetrical oligoarthritis

Answer 6

affects 1-4 joints on one side of the body

Question 7

what is symmetrical oligoarthritis

Answer 7

affects >4 joints

Question 8

what is Distal interphalangeal predominant pattern

Answer 8

affects the DIP joints primarily

Question 9

what is spondylitis

Answer 9

affects the axial skeleton

Question 10

what is arthritis mutilans

Answer 10

the most severe pattern, affects the phalanges and there is osteolysis of the bones around the joints)

Question 11

how to differentiate between psoriatic arthritis and rheumatoid arthritis

Answer 11

Psoriatic arthritis tends to affect the DIP joints and axial skeleton, whereas rheumatoid arthritis is less likely

Question 12

signs and symptoms of psoriatic arthritis

Answer 12

• Plaques of psoriasis on the skin
• Nail pitting
• Onycholysis (separation of nail and nail bed)
• Dactylitis (inflammation of entire finger)
• Enthesitis (inflammation of tendon insertions)

Question 13

how to screen for psoriatic arthritis in psoriasis patients

Answer 13

Psoriasis Epidemiological Screening Tool - it involves questions about joint pain, swelling, history of arthritis, and nail pitting.

Question 14

4 investigations for psoriatic arthritis

Answer 14

1. Labs (inflammation/autoantibodies)
2. X-rays to identify joint damage
3. MRI to detect inflammatory changes
4. Ultrasound to detect enthesitis and synovitis.

Question 15

what x ray changes are seen with psoriatic arthritis

Answer 15

1. Ankylosis (fixation/fusing of bones
2. Osteolysis (destruction of bone)
3. Dactylitis (inflammation of whole digit)
4. Periostitis (inflammation of the periosteum)

Question 16

treatment of psoriatic arthritis

Answer 16

• NSAIDS
• Steroids
• DMARDs
• Anti-TNF medications
• Monoclonal antibody to target interleukin 12 and 23 (ustekinumab)