Seronegative Inflammatory Arthropathies - Psoriatic Arthritis Flashcards

1
Q

psoriatic arthritis

A
  • inflammatory arthritis assoicated with psoriasis
  • usually an asymmetric oligoarthritis, but may affects hands with similar pattern to RA
  • Pain and swelling of joints, and stiffness, particularly in the morning.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

presentation of PA

A

common seronegative features eg

  • sacroilitis - may be associated with spondylitis
  • dactylitis
  • enthesitis
  • extra articular features eg eye
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is seen in the nails in PA

A
  • Psoriatic nail dystrophy: thickening and ridging of the nails, and oncholysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PA - clinical subgroups

A
  • confined to DIP in hands and feet
  • symmetric polyarthritis - RA like (most common)
  • spondylitis - predominantly spine and SI joints
  • asymmetric oligoarthritis with dactylitis
  • arthritis mutilans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is symmetric polyarthritis (PA) similar to

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is arthritis mutilans

A
  • particularly aggressive and destructive form of the condition that causes joint deformity
  • Characterised by resorption of bones and consequent collapse of soft tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

psoriasis in PA

A
  • People with psoriatic arthritis usually have some psoriatic skin changes eventually
  • Psoriatic arthritis develops after skin psoriasis in round 70% of patients
  • Plaque psoriasis is often seen.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

does severity of psoriasis effect severity of psoriatic arthritis

A

Severity of the skin disease does not predict the severity of the joint disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

diagnosis of PA

A

history

examination

bloods

x ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

x ray in PA

A

marginal erosion and whispering

pencin in cup deformity

osteolysis

enthesitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment for PA

A
  • Physical therapy, occupational therapy
  • NSAIDs
  • Corticosteroids, can be joint injections
  • DMARDs – usually methotrexate
  • Anti-TNF in severe unresponsive disease
  • Secukinumab (anti-IL17)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

reactive arthritis

A

occurs in response to infection in another part of the body

most commonly genitourinary or other GI infections

the infection trigges an autoimmune arthropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

RA - what are the common bacteria for genitourinary infections

A

clamydia

nesissera

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

RA - what are the common bacteria for GI infections

A

salmonella

campylobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the typical presentation of RA

A

large joints, typically of the lower limb, become inflamed around 1-4 weeks after infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

genetics RA

A

HLA B27 positive in 60-85%

17
Q

what is reiters syndrome

A

form of reactive arthritis

  • urethritis, uveitis or conjunctivitis, and arthritis
18
Q

what is the course of reactive arthritis

A

most cases are self limiting, whilst others can be chronic and have frequent relapse

19
Q

clinical features of RA

A
  • general symptoms - fever, malaise, weight loss
  • asymmetric monorathritis or oligoarthriits
  • enthesitis
  • mucocutaneous lesions
  • occular lesions
  • visceral manifestation
20
Q

keratoderma blenorrhagica

A
  • Seen in 10% of cases
  • Skin lesions commonly found on palms and soles, may spread to scrotum, scalp and trunk
  • May be confused with psoriasis
  • Vesicles that form a crust and then disappear
21
Q
A

feature of RA

keratoderma blennorrhagica

22
Q
A

feature of RA
circinate balantis

23
Q

diagnosis of RA

A

history

examination

bloods

cultures - of stool if diarrhoea

joint fluid analysis

x ray - enthesitis

opthamology

24
Q

managment of RA

A

Aimed at underlying infectious cause and symptomatic relief.

  • NSAIDs
  • Corticosteroids
  • Antibiotics for underlying infection
  • DMARDs if resistant/chronic
25
Q

enteropathic arthritis

A

inflammatory arthritis involving the peripheral joints and sometimes spine, occuring in patients with IBD

26
Q

features of EA

A

enthesiits, eye invovement, skin involvement, weight loss, low grade fever, oral apthous ulcer

27
Q

investigations for EA

A

endoscopy with biopsy for IBD

joint aspirate

inflammatory markers

28
Q

what is not a good idea to give in EA

A

NSAIDs - exacerbate IBD

29
Q

what is most inflammatory arthritis with DIP involvement

A

psoriatic arthritis