Psoriatic & Reactive Arthritis Flashcards
7-10% of patients with ____ develop psoriatic arthritis
psoriasis
A patient with more surfaces of rough skin and bad dandruff is at most risk of developing ____
joint symptoms (psoriatic arthritis)
(more severe psoriasis = ^risk)
Where is psoriasis usually located?
- extensor surfaces around elbows
- knees
- scalp (dandruff)
In a patient with psoriatic arthritis, ____ symptoms precede ____ symptoms
skin; joint
At what age do joint symptoms tend to manifest in patients with psoriatic arthritis?
between 30-50yrs
What joints are commonly affected by psoriatic arthritis?
- SI & thoracolumbar spine
- DIP jts of hands & feet
Histologically, psoriatic arthritis is similar to ____
RA
The earliest manifestation of psoriatic arthritis is in what joints?
DIP (hands)
How does psoriatic arthritis compare to RA?
- histologically similar
- less severe than RA
- more frequent remissions
- less jt destruction
- normal bone density
- asymmetric
What gene is implicated in psoriatic arthritis?
HLA-B27
What are the 2 primary histologic characteristics of psoriasis?
hyperkeratosis
parakeratosis
What is hyperkeratosis?
over proliferation of keratinocytes
How does the doubling time of keratinocytes in psoriasis compare to normal?
normal = 21 days
psoriasis = 3 days (hyperkeratosis)
What is parakeratosis?
persistence of nuclei in stratum corneum cells
(results in ^shedding of skin cells)
What are the clinical manifestations of psoriatic arthritis?
- psoriatic skin rash (flares coincide w/ jt Sx)
- dactylitis
- asymmetrical stiffness & pain (after inactivity)
- pitting (deep grooves) of finger/toe nails
- onycholysis
Describe the appearance of a psoriatic skin rash
- reddish (pinpoint hemorrhagic foci) plaques with white/silvery scale
- well-defined, inflamed borders
- neutrophilic pustules may be present
Swelling around the joints of the fingers is called ____
spindle digits
(dactylitis)
Swelling of the entire length of the digits is called ____
sausage digits
In psoriatic arthritis, dactylitis initially presents as ____, and may progress to ____
spindle digits
sausage digits
What is onycholysis?
painless separation of the nail from the bed
What are the common radiographic characteristics of psoriatic and reactive arthritis in the spine?
- marginal erosions
- fluffy periostitis
- normal bone density
- uniform narrowing of jt space
- asymmetrical sacroiliitis (bilat. or unilat.)
- paravertebral ossifications (non-marginal syndesmophytes)
- osseous ankylosis
What are the radiographic characteristics specific to psoriatic arthritis?
- marginal erosions & fluffy periostitis producing deformities (mouse ear, pencil-in-cup)
- osseous ankylosis of digits
What is another name for reactive arthritis that should not be used?
Reiter’s syndrome
What demographic is primarily affected by reactive arthritis?
- almost exclusively men (men are sluts; 50:1)
- onset in 20-30s
(historically seen in military populations)
What is the classic triad of symptoms seen in reactive arthritis?
“can’t see, can’t pee, can’t dance with me”
- conjunctivitis/uveitis
- non-gonococcal urethritis/cervicitis
- polyarthritis (SI jts & LE)
What are the most common STIs that precede reactive arthritis?
- chlamydia
- gonorrhea
(can affect HIV pts)
What genetic variant is commonly associated with reactive arthritis?
HLA-B27
What is generally the earliest symptom of reactive arthritis?
urethritis (burning & ^frequency)
What are the clinical manifestations of reactive arthritis?
- urethritis
- perfuse watery diarrhea (stool Sx)
- conjunctivitis (mild, bilat., self-limiting)
- asymmetrical polyarthritis (LE, SI jts, achilles tendonitis)
- keratoderma blennorrhagica
What is keratoderma blennorrhagica?
red bumps or pustules on the palms, soles of the feet, and trunk, resembling psoriasis, but caused by reactive arthritis
What are the radiographic characteristics specific to reactive arthritis?
- favors LE
- Lover’s heel
What is Lover’s heel?
- inflammatory erosion from the retrocalcaneal bursa adjacent to the achilles tendon insertion
- inflammatory enthesophytes at plantar fascia origin
