8 An inflammatory arthritis that occurs in a patient with psoriasis. Harrison’s Internal Medicine 17th editionA 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:
9 Clinical Features Unique to Psoriatic Arthritis: DIP joint involvement Nail changesDactylitisEnthesitisSpondylitis Lytic and periarticular new bone formation x-ray featuresIritis or UveatisMease, P., Menter, A. (2005) , Psoriatic Arthritis: Understanding Its Pathophysiology and Improving Its Diagnosis and Management. Retrieved from:
10 Clinical Features Patterns of Arthropathy Arthritis of DIP joints Asymmetric oligoarthritisSymmetric polyarthritisAxial involvementArthritis Mutilans
11 Psoriatic Arthritis Distal Interphalangeal joint arthritis Occurs in 15 % of casesNail changes also seenHarrison’s Internal Medicine 17th edition
12 Psoriatic Arthritis Asymmetric Oligoarthritis Involves the knee or any large joint with a few small joints in the fingers and toesMetarsophalangealProximal interphalengealDistal interphalengealDactylisSausage shaped digits due to inflammation of the flexor tendons and synovium and pitting edema of the distal extremities may be observedHarrison’s Internal Medicine 17th edition
13 Psoriatic Arthritis Symmetric polyarthritis Affects the Hands, wrists, knees, and feet symmetricallyProximal interphalangeal jointsMetacarpophalangeal jointsPeripheral joints are less tender compared to RAHarrison’s Internal Medicine 17th edition
14 Psoriatic Arthritis Axial Arthropathy Spine and sacroiliac joints Harrison’s Internal Medicine 17th edition
15 Psoriatic Arthritis Arthritis mutilans Widespread shortening or telescoping of digits due to osteolysis of the phalanges and metacarpalscoexisting with ankylosis and contractures in other digitsopera-glass deformity or pencil-in-cup radiographic findingsFeverHarrison’s Internal Medicine 17th edition
16 Nail Changes Pitting Horizontal ridging Onycholysis Discoloration of nail marginsDystrophic hyperkeratosisNail pittingOnycholysisOnychodystrophyHarrison’s Internal Medicine 17th edition
17 DactylitisInvolvement of the distal and proximal interphalangeal joints, together with tendon sheath involvement, may give the digit a sausage shapeHarrison’s Internal Medicine 17th edition
18 EnthesitisInflammation at the sites of ligamentous and tendinous insertionsEmedicine Retrieved from:
19 Immunocompromised due to meds Auspitz sign – break in skin integrity PsoriasisPsoriatic ArthritisCellulitisRisk Factors:Immunocompromised due to medsAuspitz sign – break in skin integrity
20 PsoriasisImmunocompromised patient due to medicationsAuspitz signBreak in the skin integrityBacteria gains access to the epidermisAcute inflammation of the dermis and subcutaneous tissueIndigenous flora colonizing the skinStaphylococcus aureusStreptococcus pyogenesExogenous bacteriaCellulitisHarrison’s Principles of Internal Medicine 17th ed.
21 Cellulitis At the involved site Fever and chills Malaise Localized painErythemaSwellingWarmthBorders are not sharply demarcatedFever and chillsMalaiseHarrison’s Principles of Internal Medicine 17th ed.
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