psoriatic arthritis

14
Psoriatic Arthritis BY EMMANUEL EZRA ABI GROUP 3

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Page 1: psoriatic  arthritis

Psoriatic ArthritisBY

EMMANUEL EZRA ABIGROUP 3

Page 2: psoriatic  arthritis

Definition

Inflammatory arthritis associated with psoriasisUsually seronegative for Rheumatoid Factor and cyclic citrullinated peptides (CCP)Classified with HLA-B27-associated spondyloarthropathies

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Epidemiology

Likely in up to 25-34% of patients with presence of skin diseaseOverall prevalence 0.04-1.2%M=F although it differs in subsetsPeak age of onset between 30-55 years

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CASPAR criteriaevidence of psoriasis

current - 2history of - 1family history of - 1

psoriatic nail dystrophy (onycholysis, pitting, hyperkeratosis)negative rheumatoid factordactylitis, either current or history ofradiological evidence of juxta-articular new bone formation

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SubtypesDIP joint patternoligoarticular (<5 joints) pattern, usually assymetricpolyarticular (>=5 joints), symmetric in halfarthritis mutilansspondyloarthritis

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Other Rheum Findings

enthesitis (inflammation at site of tendon insertion)tenosynovitis (inflammation of tendon and its enveloping sheath)dactylitis or “sausage digit”

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Extra-articular findings

skin - psoriasisnails - pits and onycholysispitting edema - often asymmetricalocular inflammation - conjunctivitis, iritis

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look for distal joint involvement in asymmetric distributionlook at the nailslook in earsask about family historydactylitis

How to diagnose those without skin

findings

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Images

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Diagnostic Testingno diagnostic laboratory testingradiologically:

erosive changes and new bone formation in distal jointslysis of terminal phalangesfluffy periostitis and new bone formation at sites of enthesitis“pencil in cup” appearance

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Differential

Reactive (Reiter’s) ArthritisRheumatoid Arthritis with concomitant psoriasisankylosing spondylitisgouty arthritis

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TreatmentNSAIDs if disease is mild.PT, OT, splinting devicesIf erosive disease, treat aggressively with DMARDs (MTX, Sulfasalazine, CsA).If skin disease is the major issue, should be managed by a dermatologist.Early referral to rheumatology for initiation of DMARDs to prevent progression.

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Course and Prognosis20% of patients have a severe an debilitating form of arthritisoriginally thought to be more benign course than RhAprogression of clinical damage occurs in a majority of patientsradiologic changes occur over time despite treatment

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