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Arthritis, Psoriatic

Arthritis, Psoriatic is a topic covered in the 5-Minute Clinical Consult.

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Basics

A chronic, destructive, seronegative arthropathy most common in patients with long-standing psoriasis

Description

  • Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by inflammatory arthritis and enthesitis.
  • Five patterns of arthritis in PsA:
    • Asymmetric oligoarthritis: <5 joints
    • Distal interphalangeal (DIP) joint predominant: osteoarthritis-like, associated with nail psoriasis
    • Symmetric polyarthritis: may be indistinguishable from rheumatoid arthritis (RA)—typically milder
    • Spondyloarthritis: asymmetric and discontinuous, unlike ankylosing spondylitis (AS)
    • Arthritis mutilans: destructive, resorptive arthritis; produces “opera-glass” or “telescoping” digit
  • Although psoriasis generally is present, it may be limited in extent.
    • Course of arthritis and extent of psoriasis do not appear to correlate.
    • Other extra-articular features, such as iritis, are less common.
    • Damaging joint disease may occur in 40–60%. Characteristic radiologic changes include “pencil-in-cup” deformity and periostitis.
  • Rheumatoid factor (RF) and cyclic citrullinated peptide antibody (anti-CCP) are usually negative. HLA-B27 may be positive.

Epidemiology

  • Peak onset age: 30 to 50 years
  • Predominant gender: female = male
  • Polyarthritis is more common in women.
  • Spondylitis in up to 25%, more common in males
  • Psoriasis precedes arthritis in most patients by an average of 12 years. Arthritis preceding psoriasis occurs in up to 15% of patients, usually children. Arthritis and psoriasis may present simultaneously.
  • Psoriasis occurs in 2–3% of the U.S. population; 6–42% will develop PsA (1).

Prevalence
Prevalence: 1 to 2/1,000 population (1)

Etiology and Pathophysiology

  • CD4+/CD8+ T cells; tumor necrosis factor α (TNF-α); interleukins 1 (IL-1), 6, 8, and 10; and matrix metalloproteases present in synovial fluid
  • Osteoclast precursor cell upregulation
  • Unknown. Probably multifactorial: immunologic, genetic, environmental factors

Genetics
  • 30–40% concordance in identical twins
  • HLA-B27 in 15–50% with PsA (spondylitis pattern) versus 90% in AS
  • Other HLA associations in PsA: HLA-B7, HLA-B38, HLA-B39, HLA-Cw6

Risk Factors

  • Psoriasis
  • Family history of PsA

General Prevention

No known prevention strategies; unknown whether early treatment of psoriasis prevents onset of PsA

Commonly Associated Conditions

Psoriasis

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Citation

Stephens, Mark B., et al., editors. "Arthritis, Psoriatic." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116052/all/Arthritis__Psoriatic.
Arthritis, Psoriatic. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116052/all/Arthritis__Psoriatic. Accessed April 21, 2019.
Arthritis, Psoriatic. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116052/all/Arthritis__Psoriatic
Arthritis, Psoriatic [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116052/all/Arthritis__Psoriatic.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Arthritis, Psoriatic ID - 116052 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116052/all/Arthritis__Psoriatic PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -