Rheum 2 - Psoriatic Arthritis

Question 1

Seronegative spondyloarthropies

Answer 1

Group of disorders characterized by:

• Axial skeletal inflammation (hips and shoulders)
• Negative RF serologies

Question 2

Types of spondyloarthropathies

Answer 2

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis (Crohns, ulcerative colitis)

Question 3

Psoriatic arthritis is what

Answer 3

Inflammatory arthritis that usually occurs with established cutaenous psoriasis - with or without nail changes

Question 4

How common is PA

Answer 4

May develop in 5-20% of those with psoriasis
Skin involvement precedes joint involvement in majority
Age onset 30-55 yrs

Question 5

Clinical findings of PA

Answer 5

Axial or peripheral stiffness, pain or swell
Dactylitis - sausage fingers or toes
Spinal stiff, pain, limited ROM
Enthesitis - inflamm of insertion of tendons (like achilles)
Nail lesions - pitting, oncholysism transverse riding
Eye disease - conjunctivitis, iritis, episcleritis

Question 6

Psoriatic Arthritis vs RA - digit involvement

Answer 6

PA can have DIP compared to RA that is usually PIP

Question 7

X ray changes with PA

Answer 7

Sof ttissue swelling and erosions

Pencil and cup deformity results from erosive changes and foramtion of hypertrophic bone in phalanges

Question 8

CASPAR - Classification for diagnosis of PA

Need how many

Answer 8

Need to have established inflammatory articular disease plus 3 or more of the categories listed

Question 9

CASPAR - Classification for diagnosis of PA - categories

Answer 9

Psoriasis - Current active (2), Personal history (1), Family history (1)
Typical psoriatic nail distrophy (1)
Neg test for RF (1)
Current or hx of dactylitis confirmed by rheumatologist (1)
Radiologic evidence of juxta-articular new bone formation in hand or foot (1)

Question 10

Tx - tests prior to tx unremarkable

Answer 10

LFTs
Creatinine
Hep B and C
Tb 
Chest xray needs to be unremarkable too

Question 11

Tx - pt has to

Answer 11

Have no problem with cutting back ETOH
In the case example - no concerns with conceiving child because of vasectomy
METHOTREXATE = gold standard - 10 mg once weekly along with folic acid every day

Question 12

Tx - one month follow up

Answer 12

Labs for methotrexate - CBC, ALT, AST, albumin, Creatinine
Inflammation labs - ESR, CRP
FOLLOW THEM EVERY 4-8 WEEKS

Question 13

Typical treatment for PS

Answer 13

NSAIDs
Corticosteroids - too much prednisone for too long can make cutaneous part worse
DMARDs - methotrexate, leflunomide, sulfasalazine
Biologic therapy - TNF inhibitors

Question 14

Typical treatment for PS - biologic therapy - TNF inhibitors

Answer 14

If someone has severe psoriasis - their psoriasis can response really well to these TNF inhibitor!
Black box warning - chance of CA and opportunistic infections

Question 15

Typical treatment for PS - biologic therapy - TNF inhibitors - approved for PA and psoriasis

Answer 15

Otelza (apremilast)

Stelara