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Psoriatic Arthritis Maggie Davis Hovda Am report 2/16/2010.

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Presentation on theme: "Psoriatic Arthritis Maggie Davis Hovda Am report 2/16/2010."— Presentation transcript:

1 Psoriatic Arthritis Maggie Davis Hovda Am report 2/16/2010

2 Definition Inflammatory arthritis associated with psoriasis One of the spondyloarthropathies

3 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

4 Clinical Presentation Joint Pain Joint Stiffness am stiffness >30 min Worse with immobility, better with physical activity

5 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

6 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

7 Psoriatic Arthritis Patterns Distal arthritis – DIP joint involvement Asymmetric oligoarthritis - < 5 joints Symmetric Polyarthritis – mimics RA Arthritis Mutilans – Destructive arthritis Spondyloarthropathy – sacroilitis and spondylitis

8 Uptodate

9 Other Features Enthesitis Tenosynovitis Dactylitis Nails Nail pits, onycholysis, hyperkeratosis Uptodate & AAFP

10 Radiographic Evaluation Pencil in Cup Deformity AAFP

11 Treatment 1 – NSAIDS 2 – DMARDS MTX Leflunomide Sulfasalazine Cyclosporine TNF α inhibitor Coordinate b/w Rheumatology and Dermatology

12 Annaliese Helene Hovda

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