Psoriatic arthritis Flashcards
What are the CASPAR classification criteria?
Presence of established inflammatory articular disase (peripheral arthritis, enthesitis, or axial)
Plus
- Presence of skin psoriasis
- Past or history hx of psoriasis
- Dactylitis
- Nail changes - pitting onycholysisi
- RF negative
- Juxta-articular new bone formation on x-ray
What percentage of psoriasis patients dev PsA?
~15%
What percentage of people with PsA have a 1st degree relative with psoriasis?
40%
What percentage of PsA patients have psoriasis first?
70%
What is the most common patterns of PsA?
Asymmetrical oligoarthritis/monoarthritis (approx 50% in Aus)
Commonly PIP and DIP joints of hands
May also be polyarthritis, spondylo-arthritis, or arthritis mutilans
What are the nail changes?
Pitting
Onycholysis
Nail plate crumbling
What is onycholysis?
Lifting of the distal nail and whiteness extending towards base
What biomarkers are there to test for?
None
What are the x-ray changes?
Erosion with new bone
“pencil in cup”
What is the role of conventional synthetic DMARDs?
For peripheral arthritis and skin manifestations
What biologics are effective?
Anti-TNF
Anti-IL17
Anti-p40 subunit IL12/23 - ustekinumab
Which other newer medications are effective?
Tofacitinib
Apremilast
Which biologic is not effective for axial disease?
IL-12/23 blockers - ustekinumab
Which biologic is not effective for IBD?
IL-17 blockers
