1 / 14

Psoriatic Arthritis

Psoriatic Arthritis. Emily Chang Morning Report August 14, 2009 August. Definition. Inflammatory arthritis associated with psoriasis Usually seronegative for Rheumatoid Factor Classified with HLA-B27-associated spondyloarthropathies. Epidemiology.

Download Presentation

Psoriatic Arthritis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Psoriatic Arthritis • Emily Chang • Morning Report • August 14, 2009 • August

  2. Definition • Inflammatory arthritis associated with psoriasis • Usually seronegative for Rheumatoid Factor • Classified with HLA-B27-associated spondyloarthropathies

  3. Epidemiology • Likely in up to 25-34% of patients with presence of skin disease • Overall prevalence 0.04-1.2% • M=F although it differs in subsets • Peak age of onset between 30-55 years

  4. CASPAR criteria • evidence of psoriasis • current - 2 • history of - 1 • family history of - 1 • psoriatic nail dystrophy (onycholysis, pitting, hyperkeratosis) • negative rheumatoid factor • dactylitis, either current or history of • radiological evidence of juxta-articular new bone formation

  5. Subtypes • DIP joint pattern • oligoarticular (<5 joints) pattern, usually assymetric • polyarticular (>=5 joints), symmetric in half • arthritis mutilans • spondyloarthritis

  6. Other Rheum Findings • enthesitis (inflammation at site of tendon insertion) • tenosynovitis (inflammation of tendon and its enveloping sheath) • dactylitis or “sausage digit”

  7. Extra-articular findings • skin - psoriasis • nails - pits and onycholysis • pitting edema - often asymmetrical • ocular inflammation - conjunctivitis, iritis

  8. How to diagnose those without skin findings • look for distal joint involvement in asymmetric distribution • look at the nails • look in ears • ask about family history • dactylitis

  9. Images

  10. Diagnostic Testing • no diagnostic laboratory testing • radiologically: • erosive changes and new bone formation in distal joints • lysis of terminal phalanges • fluffy periostitis and new bone formation at sites of enthesitis • “pencil in cup” appearance

  11. Differential • Reactive (Reiter’s) Arthritis • Rheumatoid Arthritis with concomitant psoriasis • ankylosing spondylitis • gouty arthritis

  12. Treatment • NSAIDs if disease is mild. • PT, OT, splinting devices • If erosive disease, treat aggressively with DMARDs (MTX, Sulfasalazine, CsA). • If skin disease is the major issue, should be managed by a dermatologist. • Early referral to rheumatology for initiation of DMARDs to prevent progression.

  13. Course and Prognosis • 20% of patients have a severe an debilitating form of arthritis • originally thought to be more benign course than RhA • progression of clinical damage occurs in a majority of patients • radiologic changes occur over time despite treatment

  14. References • Klippel, John. Primer on the Rheumatic Diseases. Edition 12. Atlanta, GA: Arthritis Foundation; 2001: 584-586. • Gladman, Dafna. Psoriatic arthritis. Dermatologic Therapy. Vol 22. 2009, 40-55. • www.utdol.com

More Related