Psoriatic Arthritis

Question 1

What is typical presentation of psoriatic arthritis?

Answer 1

Case study example:

Patient: 32-year-old female with history of psoriasis
Has 8-week history of shoulder pain
Responded to short course of prednisone, but rebound pain when discontinued
New onset wrist pain, unable to make a fist
PE: psoriatic plaques, no nail pitting, warmth and tenderness over PIPs and DIPs
RF negative, sed rate 2, uric acid 2.3, ANA positive 1:160

Question 2

What joints are involved in psoriatic arthritis that are not involved in RA?

Answer 2

It affects the distal interphalangeal joints (DIPs)

Question 3

T/F patients with psoriatic arthritis can have asymmetric oligoarthritis and symmetric polyarthritis of joints?

Answer 3

TRUE

Question 4

What is a sausage digit and what disease process is it associated with?

Answer 4

sausage digit is also “dactylitis” and it is associated with psoriatic arthritis
Tenosynovitis is also seen

Question 5

What is clinical presentation of psoriatic arthritis?

Answer 5

Sausage digit (dactylitis) and tenosynovitis
Asymmetric oligoarthritis, especially DIPs
Symmetric polyarthritis
Spondylitis
Arthritis mutilans
Seronegative
Associated with nail pitting,
extensive skin disease or no psoriasis plaques

Question 6

What drugs are used in the management of psoriatic arthritis?

Answer 6

NSAIDs, steroid injections
Methotrexate (helps skin and joints)
Anti-TNF agents (e.g., Adalimumab, Etancercept, Golimumab, Infliximab)

Question 7

Why is hydroxychloroquine (Plaquenil) not used frequently in the treatment of psoriatic arthritis?

Answer 7

Hydroxychloroquine (usually for RA, SLE): risk of flaring psoriasis

Question 8

What happens when prednisone is tapered with psoriatic arthritis?

Answer 8

it can cause skin flares

Question 9

What findings are commonly seen in psoriatic arthritis? 
A. Dactylitis
B. Nail pitting
C. Psoriasis
D. All of the above

Answer 9

D. all of the above