Rheumatology

Question 1

What is psoriasis?

Answer 1

Autoimmune condition affecting the skin that can lead to redness, itchiness and/or dryness which can range from small, localised patches to widespread coverage.

Question 2

In psoriatic arthritis, which condition usually, but not exclusively, occurs before the other?

Answer 2

Psoriasis usually occurs first

Question 3

What are some of the clinical features of psoriatic arthritis, and which of them is regarded as the classical feature?

Answer 3

• Dactylitis (classic feature)
• Pitting of nails (oncholysis)
• Thickening of nails
• Nail detachment
• Psoriatic skin changes

Question 4

Is rheumatoid factor positive or negative in patients with psoriatic arthritis?

Answer 4

Negative

Question 5

What can be seen on X-ray that is very highly indicative of psoriatic arthritis, and how does it arise?

Answer 5

Pencil-in-cup deformity.

Arises from the breakdown of bone as well as its resorption at the joint site.

Question 6

Which joint is most likely to experience arthritic changes in psoriatic arthritis?

Answer 6

Distal-interphalangeal joints (DIP)

Question 7

As well as the joints, what other part of the body can sometimes get inflamed and which are the most commonly affected?

Answer 7

Entheses (enthesitis)

• Achilles tendon
• Plantar fascia

Question 8

What drug classes can be used to treat psoriatic arthritis?

Answer 8

• NSAIDs (e.g. diclofenac)
• Corticosteroids (e.g. prednisone, betamethasone, hydrocortisone)
• DMARDs (e.g. methotrexate, leflunomide, sulfasalazine)
• Biologics (e.g. adalimumab, infliximab)