Seronegative Inflammatory Arthropathies - Psoriatic Arthritis Flashcards
psoriatic arthritis
- 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.
presentation of PA
common seronegative features eg
- sacroilitis - may be associated with spondylitis
- dactylitis
- enthesitis
- extra articular features eg eye
what is seen in the nails in PA
- Psoriatic nail dystrophy: thickening and ridging of the nails, and oncholysis
PA - clinical subgroups
- 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
what is symmetric polyarthritis (PA) similar to
RA
what is arthritis mutilans
- particularly aggressive and destructive form of the condition that causes joint deformity
- Characterised by resorption of bones and consequent collapse of soft tissue
psoriasis in PA
- 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.
does severity of psoriasis effect severity of psoriatic arthritis
Severity of the skin disease does not predict the severity of the joint disease
diagnosis of PA
history
examination
bloods
x ray
x ray in PA
marginal erosion and whispering
pencin in cup deformity
osteolysis
enthesitis
treatment for PA
- Physical therapy, occupational therapy
- NSAIDs
- Corticosteroids, can be joint injections
- DMARDs – usually methotrexate
- Anti-TNF in severe unresponsive disease
- Secukinumab (anti-IL17)
reactive arthritis
occurs in response to infection in another part of the body
most commonly genitourinary or other GI infections
the infection trigges an autoimmune arthropathy
RA - what are the common bacteria for genitourinary infections
clamydia
nesissera
RA - what are the common bacteria for GI infections
salmonella
campylobacter
what is the typical presentation of RA
large joints, typically of the lower limb, become inflamed around 1-4 weeks after infection
genetics RA
HLA B27 positive in 60-85%
what is reiters syndrome
form of reactive arthritis
- urethritis, uveitis or conjunctivitis, and arthritis
what is the course of reactive arthritis
most cases are self limiting, whilst others can be chronic and have frequent relapse
clinical features of RA
- general symptoms - fever, malaise, weight loss
- asymmetric monorathritis or oligoarthriits
- enthesitis
- mucocutaneous lesions
- occular lesions
- visceral manifestation
keratoderma blenorrhagica
- 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
feature of RA
keratoderma blennorrhagica
feature of RA
circinate balantis
diagnosis of RA
history
examination
bloods
cultures - of stool if diarrhoea
joint fluid analysis
x ray - enthesitis
opthamology
managment of RA
Aimed at underlying infectious cause and symptomatic relief.
- NSAIDs
- Corticosteroids
- Antibiotics for underlying infection
- DMARDs if resistant/chronic
