Psoriatic Arthritis

Maggie Davis HovdaAm report2/16/2010

Definition

Inflammatory arthritis associated with psoriasis

One of the spondyloarthropathies

Epidemiology

Affects men & women equallyOccurs in 4-6% up to 30% of patients

with known psoriasis60 – 70%: Skin psoriasis first15%: Psoriatic arthritis first15%: Skin and arthritis diagnosed at same

time

Clinical Presentation

Joint PainJoint Stiffness

am stiffness >30 minWorse 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:

Shigella Salmonella Yersinia Campylobacter Chlamydia

Triad: urethritis, conjunctivitis, arthritis

Keratoderma Blennorhagicum

Inflammatory Bowel Disease Associated Crohn’s LE distribution

AAFP

Psoriatic Arthritis Patterns

Distal arthritis – DIP joint involvementAsymmetric oligoarthritis - < 5 jointsSymmetric Polyarthritis – mimics RAArthritis Mutilans – Destructive arthritisSpondyloarthropathy – sacroilitis and

spondylitis

Uptodate

Other Features

EnthesitisTenosynovitisDactylitisNails

Nail pits, onycholysis, hyperkeratosis

Uptodate & AAFP

Radiographic Evaluation

Pencil in Cup Deformity

AAFP

Treatment

1 – NSAIDS2 – DMARDS

MTXLeflunomideSulfasalazineCyclosporineTNF α inhibitor

Coordinate b/w Rheumatology and Dermatology

Annaliese Helene Hovda