Psoriatic Arthritis

Question 1

What are the main risk factors for psoriatic arthritis?

Answer 1

• FHx
• Psoriasis rash (extensor surfaces of elbows)
• Male
• HLA B 27 assocation

Question 2

Pathophysiology of PA?

Answer 2

CD8 T cells on synovium that leads to hypervascularity, erosions and osteolysis

Question 3

Clinical presentation of articular

Answer 3

Sx:

• Asymmetrical
• DIP involved
• Inflammatory polyarthropathy (especially the small joints)

Question 4

Extra articular involvment in PA

Answer 4

• Dactylitis *
• Nails: onycholysis and pitting
• Enthesitis: plantar fasciits, achilles tendoniitis, ischial tuberosity tendoniitis * most common

Question 5

Dx of PA?

Answer 5

HLA B 27
Serology to exclude RA 
ERS and CRP increased
X-ray: DIP erosions
Uric acid to exclude gout

Question 6

How do we manage PA? What treatment additions can we add if symptoms worsen?

Answer 6

1st line: NSAIDs

• naproxen
• indometacin
• ibuprofen
• diclofenac

adjunct: physio to decrease pain and strengthen muscle joint
adjunct: corticosteroid injection

If worsen:
DMARDs:
- Methotrexate: monitor FBE, UECs, LFTs
- Sulfasalazine

Biologicals (TNF-alpha inhibitors)
- Infliximab

Question 7

What is PA’s association with metabolic syndrome?

Answer 7

After developing PA, pt’s have a higher chance of developing metabolic syndrome. Therefore management should also consider treatment of this.

Question 8

Criteria for metabolic syndrome

Answer 8

Three or more of:

• central (abdominal) obesity
• HTN
• high blood triglycerides
• low levels of high density lipoproteins (HDL)
• impaired fasting glucose (IFG) or diabetes