Psoriatic Arthritis and Enteropathic arthritis

Question 1

What are seronegative spondyloarthropathies?

Answer 1

1. Psoriatic arthritis
2. Enteropathic arthritis
3. Ankylosing Spondylitis
4. Reactive Arthritis

Question 2

What are features of seronegative spondyloarthropthies?

Answer 2

• No Rh factor
• HLA-B27
• Male>Female

Question 3

What is the epid of psoriatic arthritis?

Answer 3

1. Affects 10-20% psoriasis patients

2. Middle age

Question 4

What is the presentation of psoriatic arhtritis?

Answer 4

3 joint patterns:

1. Symmetrical polyarthritis
2. Asymmetrical pauciarthritis
3. Spondylitic

Question 5

What is symmetrical polyarthritis?

Answer 5

1. can appear similar to Rh A, more common in women
2. Typically affects hands, wrists, ankles & DIP
3. MCP is relatively spared (unlike in Rh A) .

Question 6

What is Asymmetrical pauciarthritis?

Answer 6

affects mostly digits and small bones of feet (only a few joints)

Question 7

What is Spondylitic pattern?

Answer 7

1. more common in men

2. causes back stiffness and sacroiliitis with atlanto-axial joint involvement

Question 8

What is arthritis mutilans?

Answer 8

1. characterized by osteolysis (destruction) of bones at each end within the phalanxes
2. Leads to progressive shortening of the digit which, coupled with skin folding, generates a ”telescopic finger” appearance

Question 9

What are other symptoms of psoriatic arhtirtis?

Answer 9

1. Psoriasis plaques
2. Oncholysis & pitting of nails
3. Dactylitis, Enthesitis
4. Conjunctivitis, anterior uveitis
5. Aortitis
6. Amyloidosis
7. Arthritis mutilans = most severe form

Question 10

What investigations are used in Psoratic arthirits and what does it find?

Answer 10

• XRAY
  1. periostitis
  2. ankylosis
  3. osteolysis
  4. dactylitis
  5. pencil-in-cup appearance

Question 11

What is pencil in cup appearance for psoriatic arthritis?

Answer 11

central erosion of bone next to the joint causes hollowed out cup appearance (whilst adjacent bone is narrow & “sits” inside the cup)

Question 12

What is treatment for psoriatic?

Answer 12

1. NSAIDs
2. DMARDs
   3.. Anti-TNFs
   L4. ast line = Ustekinumab (IL-12/23 mAb)
   + Derm treatment e.g., UV therapy, coal tar, emollients

Question 13

What is the epid of enteropathic arthritis?

Answer 13

Any age

Equal male:female

Question 14

What are symptoms and signs of enteropathic arthritis?

Answer 14

1. Assymetrical lower extremity arthritis
2. Symmetrical sacroiliitis
3. Enthesitis less common
4. Uveitis occasionally
5. May see erythema nodosum + pyoderma gangrenosum

Question 15

What investigation would you do and what would you see on enteropathic arthritis?

Answer 15

1. NSAIDs
2. DMARDs
3. Anti-TNFs
4. • IBD treatment