Psoriatic Arthritis -finished

Question 1

Psoriatic Arthritis Epidemiology

Answer 1

• M:F 1:1
• Onset psorias suffers
• Onset 30-50
• Usually appears 10 years after psoriasis appears

Question 2

Psoriatic arthritis Clinical manifestations

Answer 2

Peters manly morning stiffie RemEYEnds him of Nail biting ROMPs

• Morning stiffness and tiredness
• Redness / pain of eye (40% of patients)
• Nail changes: Pitting, or lifting (80% of patients)
• Decrease in joint ROM
• Pain, swelling and tenderness of joints and surrounding of ST

Question 3

Psoriatic Arthritis Typical presentation

Answer 3

Peters typical present is A SUM of money

• Asymmetrical polyarthritis
• Usually affects the IP in finger joints
• Slow progress
• May become quiescent

Question 4

Psoriatic Arthritis Pathology

Answer 4

Peters Pad had No Rheum for Extra Long College Dick

• Chronic synovitis (cf RA)
• Lymphocyte infiltration
• Exudation
• Damage and destruction and joints
• Fibrosis
• No Rheumatoid Nodules

Question 5

Psoriatic Arthritis Radiology

Answer 5

Peters Rad friend BRAD Sucks

• Blend of bone destruction and proliferation
• RA like changes in larger joints
• AS like changes in the spine
• Destruction of DIPS, PIPs & phalangeal tufts
• SIJ erosion

Question 6

Clinical variants PERIPHERAL SYMMETRICAL POLYARTHRITIS

Answer 6

Peters loves a SPA mani pedi

PERIPHERAL SYMMETRICAL POLYARTHRITIS (25%-50%)
Most common form of PsA
Generally has warm, tender and red joints.
Usually mild but 50% can develop varying degrees of progressive, destructive disease which may be disabling.
- DIPS’s and PIP’s usually ankylose
- Hands, wrist, feet and ankles may also be involved

Question 7

Clinical Variant ASYMMETRICAL MONO; OLIGOARTICULAR ARTHRITIS:

Answer 7

ASYMMETRICAL MONO & OLIGOARTICULAR ARTHRITIS (35%)
Most common presentation of PsA, slow progressing and mild with asymmetric joint involvement
- PIP’s, DIP’s and MCP’s affected first
- Large joints can be affected in 80% of cases
- Often see Dactylitis: flexor tendonitis and synovitis

Question 8

Clinical Variant SPONDYLITIS AND SACROILIITIS (AXIAL ARTHRITIS):

Answer 8

SPONDYLITIS AND SACROILIITIS (AXIAL ARTHRITIS): (25%)
Male predominant
Asymmetrical
Spondylitis is predominant
- Neck, Low back, SIJ’s and vertebrae
- Can have some peripheral joint involvement too (hands arms, hips and feet)

Question 9

Clinical Variant PERIPHERAL TYPE/ DIP DOMINANT POLYARTHRITIS:

Answer 9

DIP DOMINANT POLYARTHRITIS: (5%-10%)

• DIP’s mostly affected
• Terminal tuft involvement is classic and unique to PsA
• Nail involvement with significant paronychial inflammation and swelling of finger ends
• Nail changes include: pitting, ridging and separation

Question 10

Clinical Variant ARTHRITIS MUTILANS:

Answer 10

ARTHRITIS MUTILANS: (<5%)
Severe, deforming and destructive
Resorption of bone with dissolution of joint
Affects:
- small joints of the hands and feet
- can have Cx and low back involvement
- ‘pencil in cup’