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Psoriatic Arthritis (PsA)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Psoriatic arthritis is a type of joint inflammation, or arthritis, that occurs in combination with psoriasis. Up to 30% of people with psoriasis also develop psoriatic arthritis, which causes pain, stiffness, and swelling in and around the joints. Typically, large Joints in the lower extremities, distal joints in the fingers and toes, and the low-back and sacroiliac joints can be affected. There can also be swelling of entire fingers and toes, giving the digits a sausage-like appearance. Other symptoms can include skin rashes, nail changes, fatigue, and eye problems.
The examination
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
The diagnosis of psoriatic arthritis is largely clinical. The presence of a negative test for rheumatoid factor helps to point towards the diagnosis and this feature is included in the CASPAR criteria for diagnosing psoriatic arthritis.14 In terms of radiographical evidence, look at X-rays of the hands and feet for juxta-articular new bone formation.14
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Psoriasis affects approximately 2% of the population. Its commonest form is chronic plaque psoriasis; however, there are other forms of the skin disorder. It usually presents in late teens/early twenties or around the age of 60 and commonly is associated with a family history. There is hyperproliferation of the superficial skin layers, and it is this that is responsible for its red, scaly appearance. It is usually on the extensor surfaces, but can affect the flexure areas. Nail pitting and separation of nail from the nail bed (oncholysis) is an associated phenomenon. A small percentage of people with psoriasis can develop a psoriatic arthritis. It is one of the skin disorders associated with the Koebner phenomenon (as well as lichen planus and vitiligo), whereby skin lesions occur at a site of injury.
Psoriatic arthritis improved on risankizumab: does the presence of psoriatic arthritis mean a drug approved for psoriatic arthritis has to be prescribed?
Published in Expert Opinion on Biological Therapy, 2022
Rohan Singh, Alexandria M Brown, Warren H Chan, Morgan A Farr, Sid Venkataraman, Steven R Feldman
Psoriasis is a chronic inflammatory disease that may affect multiple systems and many patients with psoriatic arthritis have preexisting skin manifestations. Although management can involve different specialties, the treatment of both the skin and joint manifestations can overlap due to the similar underlying molecular pathophysiology. Many factors need to be considered when choosing psoriasis treatments. If a physician believes a particular treatment that is not approved for psoriatic arthritis is the best treatment for a patient’s skin lesions, the physician may not necessarily need to change the choice of treatment to a drug that is FDA-approved for psoriatic arthritis if the patient has psoriatic arthritis [18]. While FDA approval guarantees a drug is effective, lack of approval does not mean the drug is ineffective [18]. Thus, when selecting an appropriate treatment, while it may be helpful to consider the underlying mechanism and FDA approval, for many patients, including our case, choosing what we think is best for the skin may be entirely appropriate, as medications that clear the inflammation in the skin are also likely to improve inflammation in the joints, with or without FDA approval [18].
A clinical perspective on risk factors and signs of subclinical and early psoriatic arthritis among patients with psoriasis
Published in Journal of Dermatological Treatment, 2022
Alice B. Gottlieb, Joseph F. Merola
The concept of subclinical PsA was recently introduced as a phase of the progression of psoriatic disease (Figure 1) (12,14). Patients with subclinical PsA have silent joint inflammation and/or morphological changes detectable by diagnostic imaging techniques like ultrasonography, magnetic resonance imaging (MRI), computed tomography, or x-ray, but they do not otherwise fulfill the Classification for Psoriatic Arthritis (CASPAR) Study Group criteria for diagnosis of PsA (14). The continuum of PsA can include patients with psoriasis at increased risk of PsA and those with asymptomatic synovio-entheseal (joint) imaging abnormalities (Figure 1) (12,13). Up to half of all patients with psoriasis may have joint pain, enthesitis, arthralgia, and other musculoskeletal symptoms that may be suggestive but not yet diagnostic of PsA (7,12,15). The impact of subclinical PsA on psoriasis patients’ quality of life and disease burden remains uncharacterized.
Perspectives on the pharmacological management of psoriasis in pediatric and adolescent patients
Published in Expert Review of Clinical Pharmacology, 2021
Emmanuel Mahé, Maud Amy De La Bretêque, Céline Phan
Acitretin is used as the first-line systemic therapy for moderate-to-severe psoriasis in children in several countries. Its efficacy, measured as the rate of complete or almost complete disease resolution, has been estimated at 60–75% in plaque psoriasis, with higher rates being obtained in palmoplantar and generalized pustular psoriasis [1]. However, this treatment is not effective in psoriatic arthritis. The efficiency of the treatment is slow, and 2 to 3 months of therapy are usually needed before efficacy can be evaluated in plaque psoriasis, whereas pustular psoriasis may respond in as early as 3 weeks. The efficacy of acitretin can be improved by combining this treatment with phototherapy, and, potentially, with methotrexate. The absorption of acitretin is highly variable from one subject to another. It is the same for the sensitivity to this molecule. Acitretin is usually initiated at a starting dose of 0.1–0.5 mg/kg/day, after which the dose can be increased to up to 1 mg/kg/day. As the agent is only available in formulations of 10 mg and 25 mg, finding the optimal dose can be problematic. To obtain an average dose of 5 mg/kg/day, a patient would need to take 10 mg every other day. Likewise, to obtain an average dose of 15 mg/kg/day, a patient would need to alternate between taking 10 mg and 20 mg every other day. Once the treatment is effective, the dose should be gradually reduced to determine the minimum effective dose and limit the risk of adverse events [1,3,11,46].