Psoriatic Arthritis BY ABDULLAH RADWAN Definition l Inflammatory

Psoriatic Arthritis BY ABDULLAH RADWAN

Definition l Inflammatory arthritis associated with psoriasis l One of the spondyloarthropathies

Epidemiology l Affects men & women equally l Occurs in 4 -6% up to 30% of patients with known psoriasis 60 – 70%: Skin psoriasis first l 15%: Psoriatic arthritis first l 15%: Skin and arthritis diagnosed at same time l

Clinical Presentation l Joint Pain l Joint Stiffness am stiffness >30 min l Worse with immobility, better with physical activity l

Differential Diagnosis l Rheumatoid Arthritis l l Symmetric PIP, MCP, not distal Ulnar deviation, swan neck deformities Rheumatoid nodules l Ankylosing Spondylitis l l l Strong HLA B 27 association Male predominance Axial skeletal involvement – sacroilitis Bamboo spine Schober test demonstrating limited flexion Uptodate. com

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

Psoriatic Arthritis Patterns l Distal arthritis – DIP joint involvement l Asymmetric oligoarthritis - < 5 joints l Symmetric Polyarthritis – mimics RA l Arthritis Mutilans – Destructive arthritis l Spondyloarthropathy – sacroilitis and spondylitis

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Other Features l Enthesitis l Tenosynovitis l Dactylitis l Nail pits, onycholysis, hyperkeratosis Uptodate & AAFP

Radiographic Evaluation Pencil in Cup Deformity AAFP

Treatment l 1 – NSAIDS l 2 – DMARDS MTX l Leflunomide l Sulfasalazine l Cyclosporine l TNF α inhibitor l l Coordinate b/w Rheumatology and Dermatology

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