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Learn about the definition, epidemiology, clinical presentation, and differential diagnosis of psoriatic arthritis, along with radiographic evaluation and treatment options. Understand its association with psoriasis and how it differs from other arthritis types.
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Psoriatic Arthritis Maggie Davis Hovda Am report 2/16/2010
Definition • Inflammatory arthritis associated with psoriasis • One of the spondyloarthropathies
Epidemiology • Affects men & women equally • Occurs in 4-6% up to 30% of patients with known psoriasis • 60 – 70%: Skin psoriasis first • 15%: Psoriatic arthritis first • 15%: Skin and arthritis diagnosed at same time
Clinical Presentation • Joint Pain • Joint Stiffness • am stiffness >30 min • Worse with immobility, better with physical activity
Rheumatoid Arthritis Symmetric PIP, MCP, not distal Ulnar deviation, swan neck deformities Rheumatoid nodules Ankylosing Spondylitis Strong HLA B27 association Male predominance Axial skeletal involvement – sacroilitis Bamboo spine Schober test demonstrating limited flexion Differential Diagnosis Uptodate.com
Reactive Arthritis LE arthritis 1-4 weeks after an infection Infectious agents: Shigella Salmonella Yersinia Campylobacter Chlamydia Triad: urethritis, conjunctivitis, arthritis Keratoderma Blennorhagicum Inflammatory Bowel Disease Associated Crohn’s LE distribution Differential Diagnosis AAFP
Psoriatic Arthritis Patterns • Distal arthritis – DIP joint involvement • Asymmetric oligoarthritis - < 5 joints • Symmetric Polyarthritis – mimics RA • Arthritis Mutilans – Destructive arthritis • Spondyloarthropathy – sacroilitis and spondylitis
Other Features • Enthesitis • Tenosynovitis • Dactylitis • Nails • Nail pits, onycholysis, hyperkeratosis Uptodate & AAFP
Radiographic Evaluation Pencil in Cup Deformity AAFP
Treatment • 1 – NSAIDS • 2 – DMARDS • MTX • Leflunomide • Sulfasalazine • Cyclosporine • TNF α inhibitor • Coordinate b/w Rheumatology and Dermatology