Psoriatic artritis Flashcards
What percentage range of the whole population is affected by psoriasis?
1-3%
What percentage of individuals with psoriasis later develop psoriatic arthritis?
Up to 40%
What percentage of all arthritic patients develop psoriasis?
20%
In terms of cases of psoriatic arthritis, how may cases had arthritis before developing psoriasis?
Up to 60%
What is the prevalence of PsA compared to RA?
PsA prevalence is 0.67, RA prevalence is 0.8 which is greater
What is the ratio of female to male individuals with PsA?
2:1
Does the extent of psoriasis correlate strongly with the progression of arthritis?
No, there is a weak correlation
What age range is the usual onset of psoriatic arthritis?
30-55 years old
What are the 5 clinical subsets of PsA, and what percentage of all PsA cases do they each make up?
Asymmetrical olgioarthritis (40%)
Symmetrical polyarthritis (30%)
Distal interphalangeal joint arthritis (10-15%)
Psoriatic spondylitis (10-20%)
Arthritis mutilans (less than 10%)
In asymmetrical oligoarthritis PsA, are upper or lower limbs affected?
Both upper and lower limbs are affected
In asymmetrical oligoarthritis PsA, how many large and small joints are usually affected?
Up to 1-2 large joints and some small joints, so that overall up to 4 joints are affected
In asymmetrical oligoarthritis PsA, are the same joints affected on both sides of the body?
No, joints on one side of body are affected only
In asymmetrical oligoarthritis PsA, give 3 examples of commonly affected joints ?
Knees, hips, distal ends of extremities
In asymmetrical oligoarthritis PsA, list 7 common symptoms?
onycholysis (nail separates from nail bed), nail pitting, enthesitis, psoriasis patches, uveitis, joint inflammation, dactylitis
What is dactylitis?
severe swelling of digit caused by involvement of synovitis of the digit, enthesitis and inflammation of intervening tissue
In symmetrical polyarthritis PsA, what is meant by symmetrical?
Affect same joints on both sides of body
In symmetrical polyarthritis PsA, how many large and/or small joints are affected?
5 or more large and/or small joints
In symmetrical polyarthritis PsA, is the upper or lower limb affected?
Both upper and lower limbs are affected
In symmetrical polyarthritis PsA, are small or large joints more commonly affected?
Small joints more commonly affected
In symmetrical polyarthritis PsA, what joints are commonly affected?
Small joints in hands and feet
In symmetrical polyarthritis PsA, what are the common symptoms?
Same symptoms that present in asymmetrical oligoarthritis
In symmetrical polyarthritis PsA, give 2 reasons why it is mistaken for RA?
Both are symmetrical and commonly affect small joints
In symmetrical polyarthritis PsA, give 2 reasons how it is different from RA?
Seronegative RF
No extra-articular features of RA eg. no rheumatoid nodules
In Distal interphalangeal joint arthritis PsA, what joints are mainly affected?
Distal interphalangeal joints in extremities (fingers and toes)
In Distal interphalangeal joint arthritis PsA, is it asymmetrical or symmetrical?
Can be asymmetrical or symmetrical
Is Distal interphalangeal joint arthritis PsA more common in men or women?
More common in men
In Distal interphalangeal joint arthritis PsA, list 4 common symptoms?
nail pitting, cracking, onycholysis, accompanying nail disease
In psoriatic spondylitis PsA, what joints are mainly affected?
Vertebral joints
In psoriatic spondylitis PsA, list 4 common symptoms?
Inflammatory back pain, inflammatory neck pain, limited mobility, stiffness
In psoriatic spondylitis PsA, what 5 joints can also be affected?
hips, arms, legs, hands, feet
What is the most severe subset of PsA?
Arthritis mutilans
In arthritis mutilans PsA, what joints are mainly affected?
Small joints in hand, fingers, wrist
In arthritis mutilans PsA, how are joints and bones affected by the severe inflammation?
Severe inflammation causes joint deformities and bone erosion which leads to shortening of digits and limited mobility
List 5 examples of extra-articular features of PsA?
Skin lesions
Nail changes eg. pitting, onycholysis (separation of the nail from the nail bed) and subungual hyperkeratosis
Uveitis (HLA B27 positive cases)
Mouth ulcers
Colitis
In PsA, what 2 inflammatory markers are elevated?
ESR, CRP
In PsA, what 3 markers are seronegative?
RF
ANA (antinuclear antibodies)
anti-CCP
Give 3 examples of radiological changes of PsA that are seen with x-ray?
Bone erosion with narrow joint space
soft tissue swelling
Pencil in cup bone chape
What causes the pencil in cup bone shape to form in PsA?
Severe digit erosion and heterotrophic (extra-skeletal) horizontal bone formation
If there is axial involvement in PsA, what 2 radiological features are seen?
Sacroiliac joint changes
Syndesmophytes
What radiological feature of PsA is shown with MRI or ultrasound?
enthesitis
What 2 types of medications can be used for mild PsA
Analgesics
NSAIDs
What 5 medications are recommended for peripheral joint disease?
Methotrexate MTX
Sulfasalazine SZP
Leflunomide LFN
Apreimilast
Cyclosporin CyA
When can biologics be used to treat PsA?
PsA is unresponsive to DMARDs, usekinumab and secukinumab (monoclonal antibodies for resistant cases)
How should you treat a patient in which skin activity mirrors joint activity?
Treat skin disease, then joints will improve
