By Gary M. White, MD
Psoriatic arthritis/arthropathy (PA) is a seronegative spondyloarthropathy that is characterized by stiffness, pain, swelling, and tenderness of the joints and surrounding ligaments and tendons.
See also psoriasis.
Clinical subtypes include 1) Asymmetrical oligoarticular arthritis. This is the most common. PIP, DIP, knee and hip joints are commonly involved. Sausage fingers may develop 2) Distal interphalangeal arthritis. Preferential involvement of the DIP joints occurs. Nail dystrophy is common. 3) Mutilating psoriatic arthritis. Osteolysis results in severe mutilation of the hands with telescoping of the fingers. 4) Symmetrical polyarthrtitis. The pattern is reminiscent of rheumatoid arthritis. 5) Spinal form of psoriatic arthritis. Spinal involvement predominates. Ileosacral and cervical involvement also may be seen. 6) Pustulosis palmoplantaris with osteoarthritis sternoclavicularis. Including the SAPHO syndrome of synovitis, acne, pustulosis, hyperostosis and osteomyelitis. 7) POPP--psoriatic-onycho-pachydermo-periostitis (see below). The joints of the hands and fingers are most frequently involved often with nail damage. The disease may be mutilating with great loss of function. PA may preferentially have its onset postpartum or perimenopausal. A patient with PA and psoriasis has been reported to have both flare at midcycle and during menstruation.
Referral to a rheumatologist is in order. Briefly, aspirin and NSAID's are helpful for mild disease and systemic agents are used widely for moderate to severe disease.
With regard to treating both psoriasis and psoriatic arthritis, the anti-TNF-α and IL-17 agents are very effective for both. UVB, acitretin and cyclosporin do little for psoriatic arthritis. Apremilast and methotrexate help, but appear less effective than the biologics.
Psoriatic arthritis and psoriasis.
Telescoping of digits. Note, patient wearing artificial nails.
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