Psoriatic Arthritis Flashcards
Key Points:
•The exact cause of psoriatic arthritis is unknown – it is considered WHAT?
•Joint distribution?
•May or may not be associated with WHAT?
•May have additional features such as??? (3)
•Markers for RA are (usually) ???
•Lab findings are NOT specific for ???
•GI dysbiosis plays a large role is disease progression.
Key Points:
•It is considered autoimmune.
•Inflammatory asymmetric joint distribution.
•May or may not be associated with psoriasis.
•May have additional features such as dactylitis, enthesitis or inflammatory back pain.
•Markers for RA are (usually) negative.
•Lab findings are NOT specific for PsA.
•GI dysbiosis plays a large role is disease progression.
Clinical Features:
•Pain and stiffness alleviated with ???
•distal arthritis joints??? & in how many joints???
•Can be symmetric and indistinguishable from RA.
•Inflammation is deforming and destructive.
Clinical Features:
•Pain and stiffness is alleviated with physical activity.
•Usually asymmetric, distal arthritis (DIP joints & MCP) in > 5 joints
•Can be symmetric and indistinguishable from RA.
•Inflammation is deforming and destructive.
- History of psoriasis is present in ???% of patients.
* Severity of what DOES NOT correlate with the severity of the joint flares.
- History of psoriasis is present in 70% of patients.
* Severity of skin flares DOES NOT correlate with the severity of the joint flares.
- Additional features include??? (7)
* Better w/?, worse w/what?
•Additional features: Dactylitis, enthesitis, tenosynovitis, nail lesions, pitting edema, uveitis, conjunctivitis.
•Better w/movement, worse w/rest.
Really swollen
Diagnostic testing:
Diagnostic testing:
Lab testing is NOT specific and will not distinguish it from other forms of inflammatory arthritis.
Diagnosis: (7)
TQ: Which would not aid in diagnosis of Psoriatic arthritis?
2006 CASPAR Criteria: a total of at least 3 points from the following list:
- Skin psoriasis that is:
- Present – 2 points; OR
- Previously present by history – 1 point; OR
- Family history of psoriasis (if not affected) – 1 point
- Nail lesions (onycholysis, pitting, hyperkeratosis) – 1 point
- Dactylitis (present or past) – 1 point
- Negative RF – 1 point
- Juxtaarticular bone formation on X-ray (not osteophytes) – 1 point
Poor Prognosis: •Increased number of ? •Elevated? •Previous medication? •Presence of joint? •Loss of joint? •Diminished quality?
Poor Prognosis: •Increased number of actively inflamed joints •Elevated ESR •Previous medication failure •Presence of joint damage •Loss of joint function •Diminished quality of life
Conventional tx: Treatment should be initiated ASAP to? •NSAIDS? •DMARDs: ? •TNF-Inhibitors?
Conventional tx:
Treatment should be initiated ASAP to reduce joint damage
•NSAIDs
•Initial treatment for mild disease – effective in bringing inflammation down
•DMARDs: sulfasalazine, leflunomide, methotrexate, cyclosporine
•Used when arthritis does not respond to NSAIDs
•TNF-Inhibitors
•Has the largest effect in reducing joint damage
Dietary Modifications: •Eliminate food allergens? 3 •Diet? •Protein? •Avoid? •Reduction in inflammatory foods: 3
Dietary Modifications: •Eliminate food allergens: •Gluten1,2 •Dairy •Eggs
- Plant based diet
- Lean sources of protein
- Avoid alcohol/smoking
- Reduction in inflammatory foods:
- Sugar
- Red meats5
- Dairy
Dysbiosis:
- What tyope of dysbiosis are the most common?
- Herbal anti-microbial agents: 3
- Bacteria and fungal dysbiosis are the most common4,6
- Herbal anti-microbial agents:
- Berberine
- Oregano Oil
- St. John’s Wort
- Include probiotics
Immune Modulation: (8)
•Vitamin D – 2,000 – 4,000IU
•Topical vitamin D (Calcipotriene) can be used directly on psoriatic lesions
•Vitamin C
•EFA’s
•Selenium
•Zinc
•Vitamin E
•L-Carnitine
*Folic AcidToxicity?
•Always check for heavy metal toxicity or xenobiotic exposure if above treatment doesn’t work as well.
Botanical Medicine: 6
- Cucumin: 1 – 1.5g/day in divided doses
- Ginger: 8 – 10g dried or extracts/day
- Boswellia serrata: 150mg boswellic acids.
- Harpagophytum procumbens: 60mg harpagosides/day
- Valerian root: 1.5 – 3g/day
- Tripterygium wilfordii/Thunder God Vine/Lei Gong Teng –
This herb has severe side effects and should be monitored. Side effects include:
GI upset
Diarrhea
Headache
Menstrual abnormalities
Hypertension.
Tripterygium wilfordii/Thunder God Vine/Lei Gong Teng –
This herb has severe side effects and should be monitored.
Side effects include?: 5
Side effects include:
GI upset Diarrhea Headache Menstrual abnormalities Hypertension.
Sx Management: 2 creams
- Topical Mahonia (10% cream- Relieva)– applied to skin lesions9
- Topical Capsicum – alleviates pruritus in psoriasis
