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
Clement J. Michet, MD
CJM is an author of a reference cited in this monograph.
Philip S. Helliwell, MD, PhD
Senior Lecturer in Rheumatology
University of Leeds
PSH is an author of some references cited in this monograph.
Luis R. Espinoza, MD
Professor and Chief
Section of Rheumatology
Department of Internal Medicine
LSU Health Sciences Center
LRE declares that he has no competing interests.
William J. Taylor, PhD, MBChB, FAFRM, FRACP
Department of Medicine
University of Otago, Wellington
WJT is an author of some references cited in this monograph.
- 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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