An inflammatory arthritis that occurs in a patient with psoriasis. Harrisons Internal Medicine 17 th 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:
Clinical Features Unique to Psoriatic Arthritis: – DIP joint involvement DIP joint involvement – Nail changes Nail changes – Dactylitis 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:
Clinical Features Patterns of Arthropathy 1.Arthritis of DIP joints 2.Asymmetric oligoarthritis 3.Symmetric polyarthritis 4.Axial involvement 5.Arthritis Mutilans
Psoriatic Arthritis Distal Interphalangeal joint arthritis Occurs in 15 % of cases Nail changes also seen Harrisons Internal Medicine 17 th 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 Harrisons Internal Medicine 17 th 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 Harrisons Internal Medicine 17 th edition
Psoriatic Arthritis Axial Arthropathy Spine and sacroiliac joints Harrisons Internal Medicine 17 th 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 Harrisons Internal Medicine 17 th edition
Nail Changes Pitting Horizontal ridging Onycholysis Discoloration of nail margins Dystrophic hyperkeratosis Onycholysis Nail pitting Onychodystrophy Harrisons Internal Medicine 17 th edition
Dactylitis Involvement of the distal and proximal interphalangeal joints, together with tendon sheath involvement, may give the digit a sausage shape Harrisons Internal Medicine 17 th edition
Enthesitis Inflammation at the sites of ligamentous and tendinous insertions Emedicine Retrieved from:
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 Cellulitis Indigenous flora colonizing the skin Staphylococcus aureus Streptococcus pyogenes Exogenous bacteria Indigenous flora colonizing the skin Staphylococcus aureus Streptococcus pyogenes Exogenous bacteria Harrisons Principles of Internal Medicine 17 th ed.
Cellulitis At the involved site – Localized pain – Erythema – Swelling – Warmth – Borders are not sharply demarcated Fever and chills Malaise Harrisons Principles of Internal Medicine 17 th ed.