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.
History and exam
Key diagnostic factors
- personal or family history of psoriasis
- joint pain and stiffness
- peripheral arthritis
- hx of scalp or nail problems
Other diagnostic factors
- pain at site of tendon attachment
- spinal stiffness
- reduction of cervical spine mobility
- FHx of psoriasis or psoriatic arthritis
- hx of joint or tendon trauma
- HIV infection
1st investigations to order
- plain film x-rays of the hands and feet
- erythrocyte sedimentation rate and C-reactive protein
- rheumatoid factor
- anticyclic citrullinated peptide antibody
- lipid profile
- fasting blood glucose
- uric acid level
- synovial fluid aspiration and analysis
Investigations to consider
- plain film x-rays of the spine and pelvis
- MRI scan of sacroiliac joints
- joint ultrasound
limited peripheral joint disease
progressive peripheral joint disease
spondylitis and/or enthesitis
- Rheumatoid arthritis (RA)
- Erosive osteoarthritis
- Apremilast for treating active psoriatic arthritis
- Assessing, managing and monitoring biologic therapies for inflammatory arthritis (3rd edition)
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