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Psoriatic Arthritis Emily Chang Morning Report August 14, 2009 August.

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Presentation on theme: "Psoriatic Arthritis Emily Chang Morning Report August 14, 2009 August."— Presentation transcript:

1 Psoriatic Arthritis Emily Chang Morning Report August 14, 2009 August

2 Definition Inflammatory arthritis associated with psoriasis Usually seronegative for Rheumatoid Factor Classified with HLA-B27-associated spondyloarthropathies

3 Epidemiology Likely in up to 25-34% of patients with presence of skin disease Overall prevalence % M=F although it differs in subsets Peak age of onset between years

4 CASPAR criteria evidence of psoriasis current - 2 history of - 1 family history of - 1 psoriatic nail dystrophy (onycholysis, pitting, hyperkeratosis) negative rheumatoid factor dactylitis, either current or history of radiological evidence of juxta-articular new bone formation

5 Subtypes DIP joint pattern oligoarticular (<5 joints) pattern, usually assymetric polyarticular (>=5 joints), symmetric in half arthritis mutilans spondyloarthritis

6 Other Rheum Findings enthesitis (inflammation at site of tendon insertion) tenosynovitis (inflammation of tendon and its enveloping sheath) dactylitis or “sausage digit”

7 Extra-articular findings skin - psoriasis nails - pits and onycholysis pitting edema - often asymmetrical ocular inflammation - conjunctivitis, iritis

8 look for distal joint involvement in asymmetric distribution look at the nails look in ears ask about family history dactylitis How to diagnose those without skin findings

9 Images

10 Diagnostic Testing no diagnostic laboratory testing radiologically: erosive changes and new bone formation in distal joints lysis of terminal phalanges fluffy periostitis and new bone formation at sites of enthesitis “pencil in cup” appearance

11 Differential Reactive (Reiter’s) Arthritis Rheumatoid Arthritis with concomitant psoriasis ankylosing spondylitis gouty arthritis

12 Treatment NSAIDs if disease is mild. PT, OT, splinting devices If erosive disease, treat aggressively with DMARDs (MTX, Sulfasalazine, CsA). If skin disease is the major issue, should be managed by a dermatologist. Early referral to rheumatology for initiation of DMARDs to prevent progression.

13 Course and Prognosis 20% of patients have a severe an debilitating form of arthritis originally thought to be more benign course than RhA progression of clinical damage occurs in a majority of patients radiologic changes occur over time despite treatment

14 References Klippel, John. Primer on the Rheumatic Diseases. Edition 12. Atlanta, GA: Arthritis Foundation; 2001: Klippel, John. Primer on the Rheumatic Diseases. Edition 12. Atlanta, GA: Arthritis Foundation; 2001: Gladman, Dafna. Psoriatic arthritis. Dermatologic Therapy. Vol , Gladman, Dafna. Psoriatic arthritis. Dermatologic Therapy. Vol ,


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