Podcast
Questions and Answers
Which of the following DMARDs is specifically mentioned as a treatment option?
Which of the following DMARDs is specifically mentioned as a treatment option?
What treatment option is recommended for patients with severe skin inflammation?
What treatment option is recommended for patients with severe skin inflammation?
In cases of persistent arthritis, what is the recommended first-line treatment?
In cases of persistent arthritis, what is the recommended first-line treatment?
What surgical procedure has been noted to be effective for treating chronic monoarticular synovitis?
What surgical procedure has been noted to be effective for treating chronic monoarticular synovitis?
Signup and view all the answers
Which of the following is NOT a component of a rehabilitation treatment program for psoriatic arthritis?
Which of the following is NOT a component of a rehabilitation treatment program for psoriatic arthritis?
Signup and view all the answers
What is an expected outcome after surgical release of joint contractures in patients?
What is an expected outcome after surgical release of joint contractures in patients?
Signup and view all the answers
Which of the following treatments is surfacing for patients suffering from arthritis mutilans?
Which of the following treatments is surfacing for patients suffering from arthritis mutilans?
Signup and view all the answers
What is a potential benefit of wrist spontaneous fusion in patients?
What is a potential benefit of wrist spontaneous fusion in patients?
Signup and view all the answers
Which loci has the strongest association with psoriasis according to genome scans?
Which loci has the strongest association with psoriasis according to genome scans?
Signup and view all the answers
What is true regarding serum immunoglobulin levels in psoriatic arthritis patients?
What is true regarding serum immunoglobulin levels in psoriatic arthritis patients?
Signup and view all the answers
Which pathway is NOT mentioned as part of the important pathways in psoriasis pathogenesis?
Which pathway is NOT mentioned as part of the important pathways in psoriasis pathogenesis?
Signup and view all the answers
What role do ERAP1 variants play in psoriasis susceptibility?
What role do ERAP1 variants play in psoriasis susceptibility?
Signup and view all the answers
Which proinflammatory cytokine is NOT identified to have increased levels in psoriatic arthritis patients?
Which proinflammatory cytokine is NOT identified to have increased levels in psoriatic arthritis patients?
Signup and view all the answers
What cytokine profile reflects the immune dysregulation seen in psoriatic arthritis?
What cytokine profile reflects the immune dysregulation seen in psoriatic arthritis?
Signup and view all the answers
Compared to rheumatoid arthritis (RA), psoriatic arthritis patients produce which of the following to a lesser extent?
Compared to rheumatoid arthritis (RA), psoriatic arthritis patients produce which of the following to a lesser extent?
Signup and view all the answers
What is a notable difference between the inflammatory processes in psoriatic arthritis and rheumatoid arthritis?
What is a notable difference between the inflammatory processes in psoriatic arthritis and rheumatoid arthritis?
Signup and view all the answers
What is the percentage of patients with uveitis who have sacroiliitis?
What is the percentage of patients with uveitis who have sacroiliitis?
Signup and view all the answers
Which ocular finding is most commonly associated with uveitis?
Which ocular finding is most commonly associated with uveitis?
Signup and view all the answers
What is a potential cardiac complication in patients with psoriatic arthritis?
What is a potential cardiac complication in patients with psoriatic arthritis?
Signup and view all the answers
What is a characteristic laboratory finding in patients with psoriatic arthritis?
What is a characteristic laboratory finding in patients with psoriatic arthritis?
Signup and view all the answers
In which conditions might psoriasiform skin lesions be observed?
In which conditions might psoriasiform skin lesions be observed?
Signup and view all the answers
Which arthritis condition is least likely to present with deforming arthritis compared to psoriatic arthritis?
Which arthritis condition is least likely to present with deforming arthritis compared to psoriatic arthritis?
Signup and view all the answers
What distinguishes psoriatic arthritis from rheumatoid arthritis on a radiologic examination?
What distinguishes psoriatic arthritis from rheumatoid arthritis on a radiologic examination?
Signup and view all the answers
What is a common misconception about the association of psoriatic arthritis and secondary syphilis?
What is a common misconception about the association of psoriatic arthritis and secondary syphilis?
Signup and view all the answers
What is one potential benefit of weight loss for patients with psoriatic arthritis?
What is one potential benefit of weight loss for patients with psoriatic arthritis?
Signup and view all the answers
Which type of exercises should be included in a rehabilitation treatment program for psoriatic arthritis?
Which type of exercises should be included in a rehabilitation treatment program for psoriatic arthritis?
Signup and view all the answers
Why should prolonged rest be avoided in psoriatic arthritis patients?
Why should prolonged rest be avoided in psoriatic arthritis patients?
Signup and view all the answers
Which treatment modality can temporarily relieve pain and reduce joint swelling?
Which treatment modality can temporarily relieve pain and reduce joint swelling?
Signup and view all the answers
What role does education play in the rehabilitation of psoriatic arthritis patients?
What role does education play in the rehabilitation of psoriatic arthritis patients?
Signup and view all the answers
What is an appropriate approach to isometric exercises during the subacute and long-term phase of treatment?
What is an appropriate approach to isometric exercises during the subacute and long-term phase of treatment?
Signup and view all the answers
What should patients be educated about during the acute phase of psoriatic arthritis treatment?
What should patients be educated about during the acute phase of psoriatic arthritis treatment?
Signup and view all the answers
Which statement about splints in psoriatic arthritis is correct?
Which statement about splints in psoriatic arthritis is correct?
Signup and view all the answers
What is the recommended approach if a joint is swollen?
What is the recommended approach if a joint is swollen?
Signup and view all the answers
When should heat therapy be administered in relation to ROM exercises?
When should heat therapy be administered in relation to ROM exercises?
Signup and view all the answers
Which treatment is suggested for patients experiencing persistent pain after therapy?
Which treatment is suggested for patients experiencing persistent pain after therapy?
Signup and view all the answers
What modification should be made to shoes for patients with painful toes?
What modification should be made to shoes for patients with painful toes?
Signup and view all the answers
What treatment may be necessary for patients with severe chronic monoarticular synovitis?
What treatment may be necessary for patients with severe chronic monoarticular synovitis?
Signup and view all the answers
Which exercise type is particularly beneficial for patients with axial spine involvement?
Which exercise type is particularly beneficial for patients with axial spine involvement?
Signup and view all the answers
What is a common consequence of surgical release for psoriatic arthritis patients?
What is a common consequence of surgical release for psoriatic arthritis patients?
Signup and view all the answers
What should be considered if a patient has plantar fasciitis?
What should be considered if a patient has plantar fasciitis?
Signup and view all the answers
What is the recommended annual examination for patients with juvenile psoriatic arthritis?
What is the recommended annual examination for patients with juvenile psoriatic arthritis?
Signup and view all the answers
Which medication is known to potentially exacerbate psoriasis?
Which medication is known to potentially exacerbate psoriasis?
Signup and view all the answers
For patients with joint deformities, which specialist may be necessary for consultation?
For patients with joint deformities, which specialist may be necessary for consultation?
Signup and view all the answers
What should be prioritized in the care of a patient with psoriatic arthritis to manage multiple active domains of the disease?
What should be prioritized in the care of a patient with psoriatic arthritis to manage multiple active domains of the disease?
Signup and view all the answers
Which of the following is a common comorbidity associated with psoriatic arthritis?
Which of the following is a common comorbidity associated with psoriatic arthritis?
Signup and view all the answers
What type of joint protection may be helpful for patients with psoriatic arthritis?
What type of joint protection may be helpful for patients with psoriatic arthritis?
Signup and view all the answers
What is the effect of lithium withdrawal on patients with psoriatic arthritis?
What is the effect of lithium withdrawal on patients with psoriatic arthritis?
Signup and view all the answers
What primary goal should be maintained for finger function in patients with psoriatic arthritis?
What primary goal should be maintained for finger function in patients with psoriatic arthritis?
Signup and view all the answers
Study Notes
Psoriatic Arthritis Overview
- Psoriatic arthritis is a seronegative oligoarthritis most commonly found in patients with psoriasis.
- Distal joint involvement and arthritis mutilans are less common but characteristic features.
- One in five patients with psoriasis has psoriatic arthritis.
Signs and Symptoms
-
Psoriasis often precedes psoriatic arthritis, but occasionally onset may occur simultaneously, or even 20 years beforehand, up to 10 years.
-
Sometimes, arthritis appears before the psoriasis.
-
Patients may experience only pain and stiffness, with few objective findings.
-
Acute onset is reported in one third of patients.
-
Physical Examination Findings:
- Enthesopathy/enthesitis: Inflammation at tendon/ligament insertions; frequent in Achilles tendon and plantar fascia.
- Dactylitis: Sausage digits (35% of patients).
- Skin lesions: Scaly, erythematous plaques; guttate lesions; pus-filled lesions (lakes of pus); erythroderma
-
Psoriatic Nail Changes:
- Beau lines
- Leukonychia
- Onycholysis
- Oil spots
- Subungual hyperkeratosis
- Splinter hemorrhages
- Spotted lunulae
- Transverse ridging
- Cracking of the nail's free edge
- Uniform nail pitting
- Important: Psoriasis can occur in hidden areas (e.g., scalp, perineum)
Diagnosis
-
Classification Criteria for Psoriatic Arthritis (CASPAR):
- Presence of current psoriasis (score 2).
- History of psoriasis in absence of current psoriasis (score 1).
- Family history of psoriasis in absence of current/past psoriasis (score 1).
- Juxta-articular new bone formation (score 1).
- Dactylitis (score 1).
- Negative rheumatoid factor (score 1).
- Nail dystrophy (score 1)
- Required: At least 3 criteria.
-
Laboratory Findings:
- Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
- Negative rheumatoid factor in most patients.
- Increased serum uric acid in some.
- Elevated serum immunoglobulin A levels in ~2/3 of patients.
- Inflammatory synovial fluid.
Radiographic Abnormalities
- Pencil-in-cup deformity: Erosion of distal phalanx into a sharpened pencil shape.
- Arthritis mutilans: Joint-space narrowing, ankylosis.
- Increased joint space.
- Fluffy periostitis.
- Bilateral, asymmetrical, fusiform soft-tissue swelling.
- Unilateral or symmetrical sacroiliitis
- Large, nonmarginal, unilateral, asymmetrical syndesmophytes (intervertebral bony bridges)
Management
- Medical treatments include NSAIDs, JAK inhibitors, and DMARDs (methotrexate, sulfasalazine, etc.).
- In severe skin inflammation, methotrexate, retinoids, psoralen plus UVA are considered.
- Intra-articular steroid injections may be helpful.
- Surgical treatments (arthroscopic synovectomy, joint replacement, etc.) can be an option in severe cases.
- Physical therapy and rehabilitation are important components of management.
- Patient education is vital in managing symptoms and lifestyle accommodations.
Pathophysiology and Etiology
- Precise pathogenesis is not known, but genetics, environment, and immune-mediated inflammation likely play a significant role.
- Psoriasis and psoriatic arthritis share some similarities in pathogenesis but also have differences, as indicated by treatment responses.
- Genetic factors play a role in susceptibility, with correlations to specific HLA alleles found.
Epidemiology
- Psoriatic arthritis affects approximately 30% of people with psoriasis.
- Worldwide, approximately one in four people with psoriasis is estimated to have psoriatic arthritis.
- Incidence rates vary by population.
- The prevalence seems to have increased in recent decades.
Prognosis
- Psoriatic arthritis can range from mild to severe, potentially leading to significant joint damage and disability in some individuals.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
