Psoriatic Arthritis

hi this is Tom from Jared finals calm in this video I'm going to be going through psoriatic arthritis and you can find written notes on this topic at zero define or calm slash psoriatic arthritis or in the rheumatologist section of the zero de finals medicine book so let's jump straight in psoriatic arthritis is an inflammatory arthritis that's associated with psoriasis and it can vary in severity so patients might have a mild stiffening and soreness in the joint or the joint can be completely destroyed in a condition called arthritis muta Lance it occurs in about 10

to 20 percent of patients who have psoriasis the skin condition which causes rashes and scaly patches to occur on places like the elbows or on the scalp and usually it occurs within about 10 years of developing the skin changes so if you've had the skin changes for more than 10 years and they haven't developed psoriatic arthritis then it's unlikely to develop after 10 years it typically affects people in middle-age but it can occur at any age it's part of the group of conditions called seronegative spondyloarthropathies and these are seronegative inflammatory arthritis like reactive arthritis ankylosing

spondylitis and enteropathy arthritis there's a few patterns of the condition and it doesn't really affect a single pattern of joins in the same way that you find osteoarthritis or rheumatoid arthritis effect specific joints there's several recognize patterns of psoriatic arthritis one of those patterns is a symmetrical polyarthritis that presents similarly to rheumatoid and is more common in women and this affects the hands the wrists the ankles and the distal interphalangeal joints of the fingers the mCP joints or the knuckles are less commonly affected unlike in rheumatoid arthritis the classic pattern of psoriatic arthritis is an

asymmetrical porky arthritis and remember key arthritis is where they only affect a few joints and this pattern typically affects the digits so the fingers and the toes and also the joints of the feet and a final typical pattern of psoriatic arthritis is a spawned oolitic pattern and this is more common in men and it presents with back stiffness sacroiliitis and atlanta axial joint involvement at the top of the neck other areas that can be affected of a spine the Achilles tendon and the plantar fascia so what signs would you have as psoriatic arthritis well firstly

have a look at the skin and see if there's any plaques of psoriasis on the skin another sign is pitting of the nails and these are tiny pinprick like pits that occur on the fingernails another sign is Onika lysis which is a separation of the nail from the nail bed dactyl itis is a classical sign of psoriatic arthritis and dactyl itis is where you have inflammation of the full finger so that might be the full finger or the full toe and finally an Associated sign is enthis itis and this is inflammation of the entities and

remember the enthis C's are the points at which tendons insert into bones so it's that join between the tendons and the bones that gets inflamed and becomes saw there's a few other associations with psoriatic arthritis one of them is eye disease and it causes conjunctivitis and anterior uveitis another one is a or Titus so this is inflammation of the aorta or that big blood vessel that comes out of the heart and travels down through the chest and abdomen and another association is amyloidosis we have amyloid deposits throughout the body something to remember for your exams

is the psoriasis epidemiological screening tool or the pest a nice recommend that patients with psoriasis complete the pest tool to screen for psoriatic arthritis this involves asking a number of questions about joint pain swelling a history of arthritis and looking for signs of nail pitting a high score usually triggers a referral to a Rheumatologist let's talk about the x-ray changes you find in psoriatic arthritis one is periosteum this is inflammation of the periosteum which causes a thickened and an irregular outline of the boat remember that the periosteum is the coating of the bone another one

is ankylosis which is where the bones join together and cause joint stiffening because the bones are essentially fusing another is Ostia lysis which is destruction of the bone another one is dactyl itis which is inflammation of the entire digit and this will appear on an x-ray as soft tissue swelling of the entire finger or the entire toe and another final classic x-ray change is a cup in pencil appearance central erosions of the bone beside the joint so this causes the appearance of one bone in the joint being hollow and looking like a cup while the

other bone is narrow and sits inside the cup causing a pencil in cup appearance there's a condition called arthritis Mewtwo lands which need to be aware of for your exams and this is a specific severe form of psoriatic arthritis and this occurs in the phalanxes which are the bones inside the digits are inside the fingers or the toes and essentially what happens is there's Ostia lysis which is destruction of the bones around the phalanxes so either end of the phalanxes which causes the digits to shrink or get shorter because the bones in the digit are

getting shorter and this causes the skin around the finger or the toe to fold in on itself as the bones inside it gets shorter and closer together and this gives an appearance which we often call a telescopic finger so essentially the finger is getting shorter and the skin is folding in on itself like a telescope so how do we manage psoriatic arthritis well management is similar to rheumatoid arthritis and there's a crossover between the systemic treatments of psoriasis and the treatment of psoriatic arthritis so treatment is often coordinated between dermatologists and rheumatologists because the treatment

of one condition will help the other depending on the severity the patient might just require simple non-steroidal anti-inflammatory medications for pain they might require DMARDs or disease-modifying antirheumatic drugs like method right side left loon amide or sulfasalazine they can be treated with anti TNF medications like a tun acept infliximab or adalimumab and the last line is erst a canoe map which is a monoclonal antibody that targets specifically interleukin 12 and interleukin 23 and by targeting these interleukins it dampens down inflammation thanks for watching this video if you found it helpful please consider giving it a

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