Download 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
 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

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
Differential Diagnosis

Reactive Arthritis



LE arthritis
1-4 weeks after an
infection
Infectious agents:








Inflammatory Bowel
Disease Associated


Crohn’s
LE distribution
Shigella
Salmonella
Yersinia
Campylobacter
Chlamydia
Triad: urethritis,
conjunctivitis, arthritis
Keratoderma
Blennorhagicum
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

Uptodate
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
Annaliese Helene Hovda