Monday, 24 April 2017

Arthritis Risk in psoriasis

       Five percent of patients with psoriasis are affected by an inflammatory arthritis in some form. Men and women are affected with equal frequency. Psoriatic skin disease may pre-date the onset of arthritis (70% of cases), present coincident with arthritis (15% of cases), or follow the onset of arthritis (15% of cases).

       Characteristic, but not necessarily pathognomonic, features of psoriatic arthritis include nail involvement (pitting, separation from the nail bed known as “onycholysis”, and yellow discoloration known as the “oil drop” sign); dactylitis (“sausage digits”); inflammation at the sites of ligamentous and tendonous insertion (“enthesopathy”); and absence of rheumatoid factor.

       There are five clinical patterns of psoriatic arthritis, which may evolve and are not necessarily mutually exclusive:

       Symmetrical polyarticular (30-50% of cases)

       Asymmetrical oligoarticular (30-50% of cases)

       Distal interphalangeal joint involvement (25% of cases)

       Arthritis mutilans (characterized by resorption of the phalangeal bones) (5% of cases)

       Axial arthritis (includes both sacro-iliitis which may be asymmetric & spondylitis)

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