Psoriatic Arthritis

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Psoriatic Arthritis

• Maggie Davis Hovda
• Am report
• 2/16/2010

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Definition

• Inflammatory arthritis associated with psoriasis
• One of the spondyloarthropathies

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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

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Clinical Presentation

• Joint Pain
• Joint Stiffness
• am stiffness gt30 min
• Worse with immobility, better with physical
  activity

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Differential Diagnosis

• 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

Uptodate.com
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Differential Diagnosis

• 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
• Crohns
• LE distribution

AAFP
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Psoriatic Arthritis Patterns

• Distal arthritis DIP joint involvement
• Asymmetric oligoarthritis - lt 5 joints
• Symmetric Polyarthritis mimics RA
• Arthritis Mutilans Destructive arthritis
• Spondyloarthropathy sacroilitis and spondylitis

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Uptodate
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Other Features

• Enthesitis
• Tenosynovitis
• Dactylitis
• Nails
• Nail pits, onycholysis, hyperkeratosis

Uptodate AAFP
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Radiographic Evaluation
Pencil in Cup Deformity
AAFP
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Treatment

• 1 NSAIDS
• 2 DMARDS
• MTX
• Leflunomide
• Sulfasalazine
• Cyclosporine
• TNF a inhibitor
• Coordinate b/w Rheumatology and Dermatology

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Annaliese Helene Hovda