Psoriatic Arthritis

Question 1

What is psoriatic arthritis?

Answer 1

A chronic inflammatory arthritis which is associated with psoriasis.

It may be develop alongside the rash seen in psoriasis, or years later.

Question 2

What type of arthritis is psoriatic arthritis?

Answer 2

Seronegative arthritis

Question 3

How can psoriatic arthritis be classified?

Answer 3

According to the pattern of joints which are affected

Question 4

What are the 5 classifications of psoriatic arthritis?

Answer 4

1) oligoarthritis

2) symmetrical polyarthritis

3) DIP predominant

4) spondylarthritis

5) arthritis mutilans

Question 5

Describe oligoarthritis

Answer 5

<5 joint affected

tends to be asymmetrical

Question 6

What are the 2 most common presentations of psoriatic arthritis?

Answer 6

Oligoarthritis & symmetrical polyarthritis

Question 7

Describe symmetrical polyarthritis

Answer 7

Also known as ‘rheumatoid pattern’

DIPs tend to be affected rather than MCPs, as seen in RA.

Question 8

Which joints of hand tend to be affected in RA vs PA?

Answer 8

RA - MCPs & PIPs

PA - DIPs

Question 9

Which type of psoriatic arthritis is more often seen in men?

Answer 9

DIP predominant

Question 10

Clinical features of psoriatic arthritis?

Answer 10

1) Psoriasis:
- current or past psoriatic rash
- nail changes e.g. pitting, onycholysis

2) Inflammatory arthritis:
- joint pain that is WORSE after rest
- prolonged morning stiffness of >30 minutes
- improves with activity
- synovitis on exam (tenderness and swelling of joints)

3) Dactylitis

4) Enthesitis

Note - Rash/nail changes usually precede joint involvement.

Question 11

What are 2 clinical features that are specific to psoriatic arthritis?

Answer 11

1) Dactylitis

2) Enthesitis

Question 12

What is dactylitis?

Answer 12

Swelling of a whole digit

Question 13

What to do if patient presents with dactylitis?

Answer 13

NICE guidelines (2017) advise referral of anyone with dactylitis to a rheumatologist for assessment

Question 14

What is enthesitis?

Answer 14

Inflammation at the site of tendon attachment

Commonly presents as elbow, heel or lateral hip pain e.g. patient may report achilles tendonitis

Question 15

What imaging is indicated in psoriatic arthritis?

Answer 15

XR of hands & feet

Question 16

What will XR show in psoriatic arthritis?

Answer 16

• X-ray changes may be absent in early disease
• DIP joint erosion and periarticular new-bone formation
• Osteolysis and pencil-in-cup deformity in advanced disease/arthritis mutilans

Question 17

Mx of psoriatic arthritis?

Answer 17

1) Conservative

2) Symptomatic: NSAIDs, DMARDs (e.g. methotrexate)

Question 18

Complications of psoriatic arthritis?

Answer 18

1) Joint deformity (due to joint destruction)

2) Functional limitation

3) CVS risk

4) Malignancy

Question 19

What is CVS risk in psoriatic arthritis?

Answer 19

Patients with psoriatic arthritis have been shown to have higher rates of HTN and IHD.

Question 20

How is psoriatic arthritis associated with malignancy?

Answer 20

Treatment with DMARDs has been associated with an increased risk of malignancy