Psoriasis Psoriatic Arthritis Cellulitis Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis

Psoriasis Psoriatic Arthritis Cellulitis

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Psoriasis Psoriatic Arthritis Cellulitis

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Psoriatic arthritis

An inflammatory arthritis that occurs in a patient with psoriasis. Harrison’s Internal Medicine 17th edition A form of arthritis that occurs in patients with psoriasis with the hallmarks of an "inflammatory" arthritis, including joint pain, erythema, and swelling, often with prominent stiffness. Mease, P., Menter, A. (2005) , Psoriatic Arthritis: Understanding Its Pathophysiology and Improving Its Diagnosis and Management. Retrieved from: http://cme.medscape.com/viewarticle/509053

Clinical Features Unique to Psoriatic Arthritis: DIP joint involvement Nail changes Dactylitis Enthesitis Spondylitis Lytic and periarticular new bone formation x-ray features Iritis or Uveatis Mease, P., Menter, A. (2005) , Psoriatic Arthritis: Understanding Its Pathophysiology and Improving Its Diagnosis and Management. Retrieved from: http://cme.medscape.com/viewarticle/509053

Clinical Features Patterns of Arthropathy Arthritis of DIP joints Asymmetric oligoarthritis Symmetric polyarthritis Axial involvement Arthritis Mutilans

Psoriatic Arthritis Distal Interphalangeal joint arthritis Occurs in 15 % of cases Nail changes also seen Harrison’s Internal Medicine 17th edition

Psoriatic Arthritis Asymmetric Oligoarthritis Involves the knee or any large joint with a few small joints in the fingers and toes Metarsophalangeal Proximal interphalengeal Distal interphalengeal Dactylis Sausage shaped digits due to inflammation of the flexor tendons and synovium and pitting edema of the distal extremities may be observed Harrison’s Internal Medicine 17th edition

Psoriatic Arthritis Symmetric polyarthritis Affects the Hands, wrists, knees, and feet symmetrically Proximal interphalangeal joints Metacarpophalangeal joints Peripheral joints are less tender compared to RA Harrison’s Internal Medicine 17th edition

Psoriatic Arthritis Axial Arthropathy Spine and sacroiliac joints Harrison’s Internal Medicine 17th edition

Psoriatic Arthritis Arthritis mutilans Widespread shortening or telescoping of digits due to osteolysis of the phalanges and metacarpals coexisting with ankylosis and contractures in other digits opera-glass deformity or pencil-in-cup radiographic findings Fever Harrison’s Internal Medicine 17th edition

Nail Changes Pitting Horizontal ridging Onycholysis Discoloration of nail margins Dystrophic hyperkeratosis Nail pitting Onycholysis Onychodystrophy Harrison’s Internal Medicine 17th edition

Dactylitis Involvement of the distal and proximal interphalangeal joints, together with tendon sheath involvement, may give the digit a sausage shape Harrison’s Internal Medicine 17th edition

Enthesitis Inflammation at the sites of ligamentous and tendinous insertions Emedicine Retrieved from: http://emedicine.medscape.com/article/1108557-overview

Immunocompromised due to meds Auspitz sign – break in skin integrity Psoriasis Psoriatic Arthritis Cellulitis Risk Factors: Immunocompromised due to meds Auspitz sign – break in skin integrity

Psoriasis Immunocompromised patient due to medications Auspitz sign Break in the skin integrity Bacteria gains access to the epidermis Acute inflammation of the dermis and subcutaneous tissue Indigenous flora colonizing the skin Staphylococcus aureus Streptococcus pyogenes Exogenous bacteria Cellulitis Harrison’s Principles of Internal Medicine 17th ed.

Cellulitis At the involved site Fever and chills Malaise Localized pain Erythema Swelling Warmth Borders are not sharply demarcated Fever and chills Malaise Harrison’s Principles of Internal Medicine 17th ed.