Psoriatic arthritis

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Psoriatic arthritis
DIP joint Involvement Nail changes
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Psoriatic arthritis
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Nail pitting in psoriatic arthritis
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Psoriatic arthritis
Deforming arthritis
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Psoriatic arthritis- pseudorheumatoid
Looks like RA But RF psoriasis
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What is this diagnosis?
Osteoarthritis
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What is this diagnosis?
Osteoarthritis
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Beware the rare but serious.

• Conditions that may present with inflammatory
  arthritis like RA
• Polymyositis, dermatomyositis should have muscle
  weakness, RF can be low titre, do CK
• Vasculitis eg Wegeners granulomatosis always do
  U/A, renal function, RF-, ANCA , may be very
  resistant to usual RA therapy
• Neoplastic conditions resistant to usual RA
  therapy

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Case history 5

• 25 year old man, episode of diarrhoea, 3 weeks
  later onset of knee swelling, followed by ankle
  swelling and achilles tendonitis
• Unable to walk in mornings due to pain and
  stiffness
• By midday joints warmed up
• No conjunctivitis, no dysuria, diarrhoea settled,
  no rash

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Investigations

• FBC normal
• ESR 53, CRP 36
• UEC normal
• RF negative
• ANA negative
• Stool cultures- negative

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Clinical picture
Left knee effusion
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Achilles tendonitis
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(No Transcript)
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Diagnosis

• Sero-negative inflammatory arthritis reactive
  arthritis
• Think of this group if past history of diarrhoea
  (eg salmonlla), dysuria (eg chlamydia), sore
  throat (strep)
• Typical joint distribution lower limb
  asymmetrical, knee, ankle, enthesitis with
  achilles tendonitis, plantar fasciitis, sausage
  toes (dactylitis)

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Case history 6

• 35 year old man
• 3 year history of low back, buttock pain
• Worse in the morning, improves with walking
  around.
• Wakes him in early hours of the morning
• Past history of red eye many years ago, treated
  with steroid drops

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Examination and investigations

• No peripheral joint synovitis
• Back movements some limitation of lumbar
  flexion, nil else
• FBC normal
• ESR, CRP normal
• Diagnosis?
• Further investigations?

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Diagnosis

• Inflammatory back pain
• Sero-negative spondyloarthropathy
• Do pelvic Xray to look at sacro-iliac joints
• HLA-B27 antigen
• Not diagnostic test for ankylosing spondylitis
• 10 normal population HLA-B27
• 90 AS HLA-B27

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Sacri-iliitis
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Psoriatic arthritis
Ankylosing spondylitis subtype
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Joint distribution

• Symmetrical, small joint arthritis, MCP, PIP,
  wrists, MTPs /- other joints
• Think RA, psoriatic, SLE or viral
• Asymmetrical, predominantly lower limb, ankle
  knee, enthesitis
• Think sero-negative spondyloarthropathies
• Psoriatic, Reactive, ankylosing spondylitis
• Sacro-iliac (buttock) pain, spinal stiffness
• Think sero-negative spondyloarthropathies, eg
  ankylosing spondylitis