Psoriatic arthritis

Polyarticular psoriatic arthritis distinguished from rheumatoid arthritis by the presence of dactylitis and the absence of anticyclic citrullinated peptide antibodies.

Non-steroidal anti-inflammatory drugs (NSAIDs) usually sufficient to treat limited disease.

Patients with progressive peripheral arthritis (polyarthritis, joint erosions) or oligoarthritis refractory to NSAIDs and/or intra-articular corticosteroids require disease-modifying antirheumatic disease therapy (e.g., methotrexate) early in the disease course.

Tumour necrosis factor (TNF)-alpha inhibitors may be considered as second-line therapy for most disease manifestations.

Psoriatic arthritis is a chronic inflammatory joint disease associated with psoriasis. It is a seronegative inflammatory arthritis differentiated from rheumatoid arthritis (RA) by several clinical features. These include a frequent oligoarticular or monoarticular initial pattern of joint involvement, as well as distal interphalangeal joint (DIP) involvement. Dactylitis, a fusiform swelling of an entire digit, and sacroiliitis are manifestations not observed in RA. Over time, many patients will progress to a polyarticular pattern of joint involvement with erosive arthritis.