Polyarticular psoriatic arthritis distinguished from rheumatoid arthritis by presence of dactylitis and absence of anti-cyclic citrullinated peptide antibodies.
Nonsteroidal 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 disease course.
Tumor 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
CJM is an author of a reference cited in this monograph.
Senior Lecturer in Rheumatology
University of Leeds
PSH is an author of some references cited in this monograph.
Professor and Chief
Section of Rheumatology
Department of Internal Medicine
LSU Health Sciences Center
LRE declares that he has no competing interests.
Department of Medicine
University of Otago, Wellington
WJT is an author of some references cited in this monograph.
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