1. Psoriatic arthritis (PsA) Introduction
PsA-Iraj Salehi-Abari
Psoriatic arthritis (PsA) Introduction
Iraj Salehi-Abari MD.,
Internist
Rheumatologist

2. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:
Typical psoriatic skin lesion:
Demarcated erythematous plaque, with
Silvery scale, on the
Extensor surfaces of elbows & knees, in the scalp, ears, presacral areas, and
Palms and soles, perineum, genitalia
Auspitz’s sign:
Gentle scraping  pinpoint bleeding

3. Psoriasis is a disease of skin and nail
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail

4. Psoriasis is a disease of skin and nail
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail

5. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:

6. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:

7. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:

8. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:

9. PsA-Iraj Salehi-Abari
Auspitz’s sign:

10. PsA-Iraj Salehi-Abari
Auspitz’s sign:

11. PsA-Iraj Salehi-Abari
Nail lesions:
Nail pits
Onycholysis
Nailbed hyperkeratosis
Oil-drop sign
Ridging
Leukonychia (Mee’s lines)
Red spots in lunula

12. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:

13. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:

14. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:

15. Psoriasis is a disease of skin and nail:
PsA-Iraj Salehi-Abari
Psoriasis is a disease of skin and nail:

16. PsA-Iraj Salehi-Abari
Psoriatic arthritis:
. Introduction:
. Arthritis associated with psoriasis
. In the past: A variant of RA
. After that: A distinct disease:
. Negative RF
. Asymmetric arthritis, DIP
. Axial, Enthesitis
. Radiographic, Genetic
. It was a “Seronegative Rheumatism”
. Now It is an “ usually Seronegative arthritis”
. A member of Spondyloarthritis

17. PsA-Iraj Salehi-Abari
Definition:
A systemic disease with arthritis
Related to Psoriasis
Arthritis could be started:
After Psoriasis
Along with Psoriasis or
Before Psoriasis

18. PsA-Iraj Salehi-Abari
Epidemiology:
Prevalence: 1-2/1000
Incidence: 6/100,000
Sex: F = M
PsA/ Psoriasis: 14%
PsA/ Early undifferentiated arthritis: 13%
Psoriasis: peak age of onset = 5-15 years
PsA: peak age of onset = years
Race: Caucasians > non-Caucasians

19. An arthritis in a patient with Psoriasis:
PsA-Iraj Salehi-Abari
An arthritis in a patient with Psoriasis:
. Psoriatic arthritis
. Psoriasis coexistent with:
. Rheumatoid arthritis
. Osteoarthritis
. IBD related arthritis
. Gouty arthritis

20. Relation between arthritis and skin or nail lesions
PsA-Iraj Salehi-Abari
Relation between arthritis and skin or nail lesions
Psoriasis before arthritis: 70%
Psoriasis after arthritis: 15%
Synchronized Psoriasis & arthritis: 15%
No direct relationship between the activity and extention of the skin and joint lesions
Nail lesion in Psoriatic arthritis: 80-90%
Nail lesion in Psoriasis without arthritis: 46%

21. PsA-Iraj Salehi-Abari