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Feedback Rheumatology

Psoriatic Arthritis

Etiology

  • Up to 20% of pts w/ arthritis, 25-40y

Clinical features

  • Mono/oligo arthritis – most common, asymmetrical, hands and feet with synovitis
  • Polyarthritis – same as RA
  • Ankylosing spondylitis – 50% HLA- B27 (PAIR) + (uveitis)
  • DIPJ arthritis w/ nail dystrophy – pitting, onycholysis , subungal hyperkeratosis
  • Arthritis mutilans – periarticular osteolysis and bone shortening
  • Psoriatic arthritis erosion is central not juxta-articular

Diagnosis

  • Diagnosis via clinical features
  • Auto-antibodies usually –ve (seronegative)
  • XR – no juxta-articular erosions

Treatment

  • NSAID – indometicin, diclofenac, paracetamol
  • Methotrexate [25mg/week] , Sulfasalazine [500mg/meal], Etanercept [50mg/week s.c]
  • Corticosteroid injection
  • Hydroxychloroquine is avoided due to skin reactions
  • Retinoid acitretin – effective for skin lesions

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