Psoriatic Arthritis Flashcards
What are the types of spondyloarthropathy (SpA)?
1) Psoriatic arthritis
2) Axial SpA
3) Ankylosing spondylitis
4) Non-radiographic axial SpA
What percentage of psoriasis patients have psoriatic arthritis?
20-30%
What are the clinical symptoms of joint inflammation in psoriatic arthritis?
1) PIP and DIP synovitis
2) Asymmetric oligoarthritis
3) Peripheral arthritis - axial (back/sacroiliac) joints
4) Joint erosion
5) Enthesitis (rare in RA)
6) Dactylitis - inflammation/swelling of entire digit (toe), tendon involvement
7) Hyperkeratosis (nail inflammation, pitting appearance)
8) Impaired physical function and QoL
What happens in the joint in psoriatic arthritis (PsA)?
- Thick synovial membrane
- Pannus consisting of T cells, macrophages, fibroblasts, neutrophils, dendritic cells and mast cells
- Enthesitis - inflammation of enthesis (CT between tendon and bone - where tendons attach to bone)
- Inflammation
What are the hallmarks of spondyloarthropathies?
1) Enthesitis ( + new bone growth where enthesis is) - in foot may mean can’t walk
2) Dactylitis
What other conditions do people with psoriatic arthritis tend to have?
- Metabolic syndrome
- High BMI
- Central obesity
What imaging technique is used to assess inflammation of the joint in psoriatic arthritis?
US (red = inflammation)
Why do you want to achieve low disease activity in PsA?
- Improves function and QoL
- Prevents joint damage
- May still be one or two holes, not a problem if treat early
What would an MRI scan with gadolinium uptake of the wrist in PsA look like after therapy?
White inflammation areas not present anymore
What is the M:F ratio in PsA?
1:1
In most cases, does PsA precede or come after the development of psoriasis?
Comes after
Is the severity of psoriasis predictive of the severity of PsA?
No but it is correlated with occurrence of PsA
What are the main symptoms of inflammatory arthritis?
- Early morning stiffness lasting at least 30 minutes
- Persistent stiffness (weeks, months)
- Lower back pain which can wake pt up and gets better with exercise (opposite to degenerative disc disease)
- Fatigue
- Often multiple joint involvement
- Swelling
- FH of autoimmune disease
What is important to listen to in PsA?
The symptoms and history bc the hands often look normal
What are the 3 main types of PsA?
1) Polyarticular
2) Oligoarticular
3) Spondyloarthritis
Describe polyarticular PsA
- Involvement of many small joints usually in hands and feet
- Most common type > 50%
- Rarely v rapid joint damage leading to arthritis mutilans
Describe oligoarticular PsA
Affects a few large joints e.g. knee, ankle, elbow
Describe spondyloarthritis PsA
Involvement of sacroiliac joints and spine, sometimes also with an oligoarticular peripheral arthritis
Why does inflammation in the achilles tendon occur in PsA and why does it look white on a scan?
Enthesitis - white bc of water/growth of new bone (achilles tendonitis)
What score is used to assess severity of ankylosing spondylitis?
BASDAI
What does ankylosing spondylitis look like in imaging?
- MRI = white, inflammation of spine
- X ray = sacroiliitis with X ray sign
- X ray = bamboo spine (new bone, back of spine fuses)
Which diseases do the genetics of PsA overlap with?
1) Psoriasis
2) IBD (Crohn’s)
3) Ankylosing spondylitis
- NOT RA
Does PsA have a strong genetic component?
Yes (30-40% heritability in twin studies)
What are the challenges in PsA?
1) Diversity in clinical manifestations of psoriatic disease
2) Musculoskeletal manifestations and abnormal blood results not so obvious and may be difficult to diagnose
3) Many patients with PsA remain undiagnosed and untreated
4) Delays in diagnosis can lead to progression of disease
