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Psoriatic Arthritis

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

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Psoriatic Arthritis

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  1. Psoriatic Arthritis Maggie Davis Hovda Am report 2/16/2010

  2. Definition • Inflammatory arthritis associated with psoriasis • One of the spondyloarthropathies

  3. 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

  4. Clinical Presentation • Joint Pain • Joint Stiffness • am stiffness >30 min • Worse with immobility, better with physical activity

  5. 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

  6. 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

  7. Psoriatic Arthritis Patterns • Distal arthritis – DIP joint involvement • Asymmetric oligoarthritis - < 5 joints • Symmetric Polyarthritis – mimics RA • Arthritis Mutilans – Destructive arthritis • Spondyloarthropathy – sacroilitis and spondylitis

  8. Uptodate

  9. Other Features • Enthesitis • Tenosynovitis • Dactylitis • Nails • Nail pits, onycholysis, hyperkeratosis Uptodate & AAFP

  10. Radiographic Evaluation Pencil in Cup Deformity AAFP

  11. Treatment • 1 – NSAIDS • 2 – DMARDS • MTX • Leflunomide • Sulfasalazine • Cyclosporine • TNF α inhibitor • Coordinate b/w Rheumatology and Dermatology

  12. Annaliese Helene Hovda

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