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NYCC MSP > Psoriatic & Reactive Arthritis > Flashcards

Psoriatic & Reactive Arthritis Flashcards

1
Q

7-10% of patients with ____ develop psoriatic arthritis

A

psoriasis

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2
Q

A patient with more surfaces of rough skin and bad dandruff is at most risk of developing ____

A

joint symptoms (psoriatic arthritis)
(more severe psoriasis = ^risk)

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3
Q

Where is psoriasis usually located?

A
  • extensor surfaces around elbows
  • knees
  • scalp (dandruff)
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4
Q

In a patient with psoriatic arthritis, ____ symptoms precede ____ symptoms

A

skin; joint

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5
Q

When do joint symptoms tend to manifest in patients with psoriatic arthritis?

A

between 30-50yrs

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6
Q

What joints are commonly affected by psoriatic arthritis?

A
  • SI & thoracolumbar spine
  • DIP jts of hands & feet
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7
Q

Histologically, psoriatic arthritis is similar to ____

A

RA

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8
Q

The earliest manifestation of psoriatic arthritis is in what joints?

A

DIP (hands)

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9
Q

How does psoriatic arthritis compare to RA?

A
  • histologically similar
  • less severe than RA
  • more frequent remissions
  • less jt destruction
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10
Q

What gene is implicated in psoriatic arthritis?

A

HLA-B27

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11
Q

What are the 2 primary histologic characteristics of psoriasis?

A

hyperkeratinosis
parakeratosis

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12
Q

What is hyperkeratosis?

A

over proliferation of keratinocytes

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13
Q

How does the doubling time of keratinocytes in psoriasis compare to normal?

A

normal = 21 days
psoriasis = 3 days (hyperkeratosis)

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14
Q

What is parakeratosis?

A

persistence of nuclei in stratum corneum cells
(results in ^shedding of skin cells)

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15
Q

What are the clinical manifestations of psoriatic arthritis?

A
  • psoriatic skin rash
  • dactylitis
  • asymmetrical stiffness & pain (after inactivity)
  • rash flares coincide w/ jt Sx
  • pitting (deep grooves) of finger/toe nails
  • onycholysis
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16
Q

Describe the appearance of a psoriatic skin rash

A
  • reddish (pinpoint hemorrhagic foci) plaques with white/silvery scale
  • well-defined, inflamed borders
  • neutrophilic pustules may be present
17
Q

Swelling around the joints of the fingers is called ____

A

spindle digits
(dactylitis)

18
Q

Swelling of the entire length of the digits is called ____

A

sausage digits

19
Q

In psoriatic arthritis, dactylitis initially presents as ____, and may progress to ____

A

spindle digits
sausage digits

20
Q

What is onycholysis?

A

painless separation of the nail from the bed

21
Q

What are the common radiographic characteristics of psoriatic and reactive arthritis in the spine?

A
  • marginal erosions
  • fluffy periostitis
  • normal bone density
  • uniform narrowing of jt space
  • asymmetrical sacroiliitis (bilat. or unilat.)
  • paravertebral ossifications (non-marginal syndesmophytes)
  • osseous ankylosis
22
Q

What are the radiographic characteristics specific to psoriatic arthritis?

A
  • marginal erosions & fluffy periostitis producing deformities (mouse ear, pencil-in-cup)
  • osseous ankylosis of digits
23
Q

What is another name for reactive arthritis that should not be used?

A

Reiter’s syndrome

24
Q

What demographic is primarily affected by reactive arthritis?

A
  • almost exclusively men (men are sluts; 50:1)
  • onset in 20-30s
    (historically seen in military populations)
25
Q

What is the classic triad of symptoms seen in reactive arthritis?

A

“can’t see, can’t pee, can’t dance with me”
- conjunctivitis/uveitis
- non-gonococcal urethritis/cervicitis
- polyarthritis (SI jts & LE)

26
Q

What are the most common STIs that precede reactive arthritis?

A
  1. chlamydia
  2. gonorrhea
    (can affect HIV pts)
27
Q

What genetic variant is commonly associated with reactive arthritis?

A

HLA-B27

28
Q

What is generally the earliest symptom of reactive arthritis?

A

urethritis (burning & ^frequency)

29
Q

What are the clinical manifestations of reactive arthritis?

A
  • urethritis
  • perfuse watery diarrhea (stool Sx)
  • conjunctivitis (mild, bilat., self-limiting)
  • asymmetrical polyarthritis (LE, SI jts, achilles tendonitis)
  • keratoderma blennorrhagica
30
Q

What is keratoderma blennorrhagica?

A

red bumps or pustules on the palms, soles of the feet, and trunk, resembling psoriasis, but caused by reactive arthritis

31
Q

What are the radiographic characteristics specific to reactive arthritis?

A
  • favors LE
  • Lover’s heel
32
Q

What is Lover’s heel?

A
  • inflammatory erosion from the retrocalcaneal bursa adjacent to the achilles tendon insertion
  • inflammatory enthesophytes at plantar fascia origin

NYCC MSP (33 decks)

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