Psoriatic arthritis

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.