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Dr. Maria Michailidou


Η                                               PSORIATIC ARTHRITIS

Arthritis occurs in about 10% of patients with psoriasis. Psoriatic arthritis typically develops after, or coincident with, the onset of psoriasis, but the arthritis precedes the skin disease by as much as 2 years in a minority of cases (~15%). A range of joint manifestations occurs in association with psoriasis: monarticular or oligoarticular arthritis, polyarthritis, arthritis mutilans, and arthritis of the axial skeleton.

Two-thirds of patients with psoriatic arthritis have an asymmetric oligoarthritis or a monoarthritis, but others have polyarticular disease that mimics osteoarthritis or rheumatoid arthritis in its distribution. Involvement of the distal interphalangeal joints, which are spared by rheumatoid arthritis, can help distinguish psoriatic arthritis from rheumatoid arthritis. Psoriatic arthritis of the distal interphalangeal joints is associated with abnormalities of the nail bed and dystrophic changes of the nail, such as pitting, onycholysis, ridging, and brown-yellow discoloration (oil-drop sign).

The skin disease can be subtle. When psoriatic arthritis is suspected based on the distribution of affected joints or suspicious radiographic findings, skin examination should include evaluation of the gluteal fold, umbilical region, and scalp because cutaneous findings can be limited to these sites. Of significance, the explosive development of psoriatic skin disease, with or without articular involvement, can be a sign of HIV infection and should prompt appropriate testing

Psoriatic arthritis has a distinctive radiographic appearance, specifically the concurrence of both bony destruction and proliferation at an affected site . In addition, psoriatic arthritis can be highly destructive, with development of a pencil-in-cup appearance of the finger bones, and in some cases, arthritis mutilans. Involvement of the axial skeleton resembles that of reactive arthritis. Sacroiliitis is usually unilateral, and nonmarginal syndesmophytes characterize the spondylitis.


NSAIDs are used for mild disease. Once-weekly methotrexate is effective for treatment of both the cutaneous and peripheral articular disease. Sulfasalazine is superior to placebo in the treatment of joint disease, but the effect, although statistically significant, is small. Anti-TNF therapies show considerable promise and improve both the articular and cutaneous manifestations of psoriatic arthritis. Cyclosporine A has been used with severe, refractory disease.

Oral glucocorticoids should be avoided, but intra-articular injections of glucocorticoids can be useful adjunctive therapy. Care should be taken to make certain that the needle does not pass through psoriatic plaques, which are heavily contaminated with bacteria. Psoriatic skin lesions overlying a joint are a contraindication to arthrocentesis because of the added risk of procedure-induced septic arthritis.

nails in psoriasic arthritis skin psoriasic arthritis

Psoriasic arthritis