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: 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 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