Psoriatic Arthritis Flashcards
Pattern of PA
Symmetrical polyarthritis
Asymmetrical pauciarthritis
Spondylitic pattern
Symmetrical polyarthritis
Presents similarly to rheumatoid arthritis
More common in women
Hands, wrists, ankles and DIP joints
MCP joints are less commonly affected (unlike rheumatoid)
Asymmetrical pauciarthritis
Affecting mainly the digits
Spondylitic pattern
More common in men
Back stiffness
Sacroiliitis
Atlanto-axial joint involvement
Signs of PA (5)
Plaques of psoriasis on the skin
Pitting of the nails
Onycholysis (separation of the nail from the nail bed)
Dactylitis (inflammation of the full finger)
Enthesitis (inflammation of the entheses, which are the points of insertion of tendons into bone)
(Other associations - Eye disease [conjunctivitis and anterior uveitis], aortitis (inflammation of the aorta),
Amyloidosis
What is PEST?
Psoriasis Epidemiological Screening Tool
NICE recommend for patients with psoriasis to screen for psoriatic arthritis
High score triggers a referral to a rheumatologist
Xray changes in PA
Soft tissue swelling - Dactylitis - inflammation of the whole digit
Osteolysis - destruction of bone
Ankylosis - bones join together causing stiffening
Periostitis - inflammation of the periosteum - causes thickened and irregular outline of the bone
Pencil-in-cup appearance - CLASSIC
What is arthritis mutilans?
Most severe form of psoriatic arthritis
Occurs in the phalanxes
Osteolysis (destruction) of the bones around the joints in the digits - leads to shortening of the digit
“telescopic finger” appearance
Management of PA
Often coordinated between dermatologists and rheumatologists
NSAIDs for pain
DMARDS (methotrexate, leflunomide or sulfasalazine)
Anti-TNF medications (etanercept, infliximab or adalimumab)
Ustekinumab is last line (after anti-TNF medications) and is a monoclonal antibody that targets interleukin 12 and 23
