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Psoriatic Arthritis (Psa)

Polyarthritis & psoriasis are often seen together and only in some cases, the patient has true psoriatic arthritis characterized by seronegative polysynovitis erosive (sometimes very destructive) arthritis and a significant incidence of sacroilitis and spondylitis

  1. Epidemiology
    1. Prevalence of psoriasis is 1-2% and PsA develop only in 5- l0% of these
      1. Psoriasis is more common in caucasians,
      2. 60% of those with spondylitis or sacroilitis have HLA — B27
      3. PsA is associated with HLA DR7.
      4. Rheumatoid factor is almost always negative
  2. Clinical Features
    1. Five patterns of joint involvement are
      1. Arthritis of DIP joint (15%)
      2. Asymmetrical oligoarthritis (30%)
      3. Symmetrical polyarthritis similar to RA (40%)
      4. Axial involvement (spine & sacroiliac joint) — 5%
      5. Arthritis mutilans (—5%)
    2. Nail changes occur in 90% patients of PsA (40% in patient without arthritis).
    3. Shortening of digitis (telescoping) because of underlying osteolysis is characteristic of PsA
    4. Fibrous & bony ankylosis of small joints (greater tendency than RA)
    5. Almost any peripheral joint can be involved. Peripheral joints in PsA are less tender than RA
    6. Sacrolitis and spondylitis is seen in one third patients. More neck involvement with less thoraco lumbar spine involvement distinguish axial PsA from ankylosing spondylitis.
    7. Conjunctivitis & bilateral chronic ureitis in ~ 30%

Sausage Digit (Dactylitis)

Description: images (17)

Pencil in cup deformity


Arthritis mutilans

  1. Radiological Feature
    1. DIP involvement, & classical pencil in cup deformity
    2. Marginal erosion with adjacent bony proliferation, (whiskering)
    3. Small joint ankylosis
    4. Osteolysis of phalangeal and metacarpal bone, with telescoping of digits
    5. Periostitis and proliferative new bone at sites of enthesitis
    6. Severe cervical spine involvement with atlantoaxial subluxation, but relative sparing of thoracolumbar spine, and paravertebral ossification.
  2. Treatment
    1. Anti TNF - a agents eg etanercept and infliximab are newer drugs and are effective even in longstanding resistent PsA cases (to previous therapy) and extensive skin lesion
    2. Methotrexate is drug of choice Other effective agents are sulfasalazine, cyclosporine retinoic acid & psoralen & UV-A (PUVA)

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