Psoriatic arthritis: Difference between revisions

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== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with [disease name] remain asymptomatic for [duration/years].  
* Psoriatic arthritis goes through the following stages of progression during its course, defined by the change in clinical damage:<ref name="pmid15708927">{{cite journal |vauthors=Gladman DD, Antoni C, Mease P, Clegg DO, Nash P |title=Psoriatic arthritis: epidemiology, clinical features, course, and outcome |journal=Ann. Rheum. Dis. |volume=64 Suppl 2 |issue= |pages=ii14–7 |year=2005 |pmid=15708927 |pmc=1766874 |doi=10.1136/ard.2004.032482 |url=}}</ref>
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
* '''Stage 1:'''
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
** Reflects no damaged [[Joint|joints]]
* '''Stage 2:'''
** One to four damaged [[Joint|joints]]
* '''Stage 3:'''
** Five to nine damaged [[Joint|joints]]
* '''Stage 4:'''
** More than 10 [[Joint|joints]]
*Common complications or [[Comorbidity|comorbid conditions]] associated with psoriatic arthritis include:<ref name="pmid16981296">{{cite journal |vauthors=Han C, Robinson DW, Hackett MV, Paramore LC, Fraeman KH, Bala MV |title=Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis |journal=J. Rheumatol. |volume=33 |issue=11 |pages=2167–72 |date=November 2006 |pmid=16981296 |doi= |url=}}</ref><ref name="pmid24115739">{{cite journal |vauthors=Labitigan M, Bahče-Altuntas A, Kremer JM, Reed G, Greenberg JD, Jordan N, Putterman C, Broder A |title=Higher rates and clustering of abnormal lipids, obesity, and diabetes mellitus in psoriatic arthritis compared with rheumatoid arthritis |journal=Arthritis Care Res (Hoboken) |volume=66 |issue=4 |pages=600–7 |date=April 2014 |pmid=24115739 |pmc=3969762 |doi=10.1002/acr.22185 |url=}}</ref><ref name="pmid26493817">{{cite journal |vauthors=Eder L, Wu Y, Chandran V, Cook R, Gladman DD |title=Incidence and predictors for cardiovascular events in patients with psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=75 |issue=9 |pages=1680–6 |date=September 2016 |pmid=26493817 |doi=10.1136/annrheumdis-2015-207980 |url=}}</ref><ref name="pmid18163513">{{cite journal |vauthors=Rohekar S, Tom BD, Hassa A, Schentag CT, Farewell VT, Gladman DD |title=Prevalence of malignancy in psoriatic arthritis |journal=Arthritis Rheum. |volume=58 |issue=1 |pages=82–7 |date=January 2008 |pmid=18163513 |doi=10.1002/art.23185 |url=}}</ref><ref name="pmid24692521">{{cite journal |vauthors=McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD |title=Depression and anxiety in psoriatic disease: prevalence and associated factors |journal=J. Rheumatol. |volume=41 |issue=5 |pages=887–96 |date=May 2014 |pmid=24692521 |doi=10.3899/jrheum.130797 |url=}}</ref><ref name="pmid23326962">{{cite journal |vauthors=Ciacli C, Cojocaru M |title=Systemic osteoporosis--major complication of psoriatic arthritis |journal=Rom J Intern Med |volume=50 |issue=2 |pages=173–8 |date=2012 |pmid=23326962 |doi= |url=}}</ref><ref name="pmid19147616">{{cite journal |vauthors=Curtis JR, Beukelman T, Onofrei A, Cassell S, Greenberg JD, Kavanaugh A, Reed G, Strand V, Kremer JM |title=Elevated liver enzyme tests among patients with rheumatoid arthritis or psoriatic arthritis treated with methotrexate and/or leflunomide |journal=Ann. Rheum. Dis. |volume=69 |issue=1 |pages=43–7 |date=January 2010 |pmid=19147616 |pmc=2794929 |doi=10.1136/ard.2008.101378 |url=}}</ref>
*Common complications or [[Comorbidity|comorbid conditions]] associated with psoriatic arthritis include:<ref name="pmid16981296">{{cite journal |vauthors=Han C, Robinson DW, Hackett MV, Paramore LC, Fraeman KH, Bala MV |title=Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis |journal=J. Rheumatol. |volume=33 |issue=11 |pages=2167–72 |date=November 2006 |pmid=16981296 |doi= |url=}}</ref><ref name="pmid24115739">{{cite journal |vauthors=Labitigan M, Bahče-Altuntas A, Kremer JM, Reed G, Greenberg JD, Jordan N, Putterman C, Broder A |title=Higher rates and clustering of abnormal lipids, obesity, and diabetes mellitus in psoriatic arthritis compared with rheumatoid arthritis |journal=Arthritis Care Res (Hoboken) |volume=66 |issue=4 |pages=600–7 |date=April 2014 |pmid=24115739 |pmc=3969762 |doi=10.1002/acr.22185 |url=}}</ref><ref name="pmid26493817">{{cite journal |vauthors=Eder L, Wu Y, Chandran V, Cook R, Gladman DD |title=Incidence and predictors for cardiovascular events in patients with psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=75 |issue=9 |pages=1680–6 |date=September 2016 |pmid=26493817 |doi=10.1136/annrheumdis-2015-207980 |url=}}</ref><ref name="pmid18163513">{{cite journal |vauthors=Rohekar S, Tom BD, Hassa A, Schentag CT, Farewell VT, Gladman DD |title=Prevalence of malignancy in psoriatic arthritis |journal=Arthritis Rheum. |volume=58 |issue=1 |pages=82–7 |date=January 2008 |pmid=18163513 |doi=10.1002/art.23185 |url=}}</ref><ref name="pmid24692521">{{cite journal |vauthors=McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD |title=Depression and anxiety in psoriatic disease: prevalence and associated factors |journal=J. Rheumatol. |volume=41 |issue=5 |pages=887–96 |date=May 2014 |pmid=24692521 |doi=10.3899/jrheum.130797 |url=}}</ref><ref name="pmid23326962">{{cite journal |vauthors=Ciacli C, Cojocaru M |title=Systemic osteoporosis--major complication of psoriatic arthritis |journal=Rom J Intern Med |volume=50 |issue=2 |pages=173–8 |date=2012 |pmid=23326962 |doi= |url=}}</ref><ref name="pmid19147616">{{cite journal |vauthors=Curtis JR, Beukelman T, Onofrei A, Cassell S, Greenberg JD, Kavanaugh A, Reed G, Strand V, Kremer JM |title=Elevated liver enzyme tests among patients with rheumatoid arthritis or psoriatic arthritis treated with methotrexate and/or leflunomide |journal=Ann. Rheum. Dis. |volume=69 |issue=1 |pages=43–7 |date=January 2010 |pmid=19147616 |pmc=2794929 |doi=10.1136/ard.2008.101378 |url=}}</ref>
** [[Metabolic syndrome]]
** [[Metabolic syndrome]]

Revision as of 19:39, 24 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Chandrakala Yannam, MD [2]

Overview

Historical Perspective

  • [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
  • In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
  • In [year], the first [discovery] was developed by [scientist] to treat/diagnose [dis

Classification

  • Based on the severity, psoriatic arthritis may be classified into following categories:
    • Mild psoriatic arthritis
    • Moderate psoriatic arthritis
    • Severe psoriatic arthritis
Organ system involvement Mild psoriatic arthritis Moderate psoriatic arthritis Severe psoriatic arthritis
Peripheral arthritis <5 joints involvement

No damage can be seen on x-ray

No loss of physical function

Minimal impact on patient's quality of life

⩾5 joints involvement

Damage can be visible on xray

Non-responsive to NSAIDs

Moderate impact on patient's quality of life

⩾5 joints involvement

Severe damage may be seen on x-ray Nonresponsive to NSAIDs, standard DMARDs

Severe impact on patient's quality of life

Axial joint involvement Mild pain present

No loss of physical function

Loss of physical function

Bath Ankylosing Spondylitis Disability Activity Index (BASDAI) >4

Failure of response
Skin Body Surface Area ( BSA) <5

Psoriasis area and severity index (PASI) <5

Resistant to topical therapy

Dermatology Life Quality Index (DLQI)<10

PASI<10

BSA>10, DLQI>10PASI>10
Dactylitis +/- Pain

Normal activity/ function

Presence of erosive disease or loss of physical function Failure of response to NSAIDs and conventional DMARDs
Enthesitis Number of sites involved:1–2

No loss of physical function

Number of sites involved >2

or

Loss of function

Loss of function

>2 sites involvement and failure of response

Causes

There are no established causes of psoriatic arthritis. The occurrence of psoriatic arthritis is secondary to a combination of genes, immune mechanisms and exposure to specific external factors or triggers, which increase an individual's risk of developing psoriatic arthritis. These risk factors lead to complex interactions between the geneticsimmune system, and the environment.[1]

Pathophysiology

The pathogenesis of psoriatic arthritis (PsA) involves the following events:[2]

Osteoclast mediated joint destruction

Differentiating psoriatic arthritis from other Diseases

  • Psoriatic arthritis must be differentiated from other arthritides including rheumatoid arthritis, reactive arthritis, ankylosing spondylitis, arthritis associated with inflammatory bowel disease, osteoarthritis, and gout.[3][4][5][6]


Epidemiology and Demographics

  • The prevalence of psoriatic arthritis in general population ranges from 60 - 250 cases per 100,000 individuals in United states.[7]
  • The prevalence ranges in genreal population from 50 - 210 cases per 100,000 individuals in Europe.[8]
  • The prevalence among psoriasis patients is 11,000 per 100,000 individuals.
  • The incidence of psoriatic arthritis is 3.6-6 per 100,000 individuals.[8]

Age

Gender

Race

Risk Factors

  • Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

Psoriatic-arthritis of hands showing pencil-in-cup deformity - By Case courtesy of Dr Jeremy Jones, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8798">rID: 8798</a>

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

  1. Barnas JL, Ritchlin CT (November 2015). "Etiology and Pathogenesis of Psoriatic Arthritis". Rheum. Dis. Clin. North Am. 41 (4): 643–63. doi:10.1016/j.rdc.2015.07.006. PMID 26476224.
  2. Ritchlin CT, Haas-Smith SA, Li P, Hicks DG, Schwarz EM (2003). "Mechanisms of TNF-alpha- and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis". J. Clin. Invest. 111 (6): 821–31. doi:10.1172/JCI16069. PMC 153764. PMID 12639988.
  3. 3.0 3.1 Helliwell PS, Taylor WJ (March 2005). "Classification and diagnostic criteria for psoriatic arthritis". Ann. Rheum. Dis. 64 Suppl 2: ii3–8. doi:10.1136/ard.2004.032318. PMC 1766878. PMID 15708931.
  4. McEwen C, DiTata D, Lingg C, Porini A, Good A, Rankin T (1971). "Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. A comparative study". Arthritis Rheum. 14 (3): 291–318. PMID 5562018.
  5. Helliwell PS, Hickling P, Wright V (March 1998). "Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis?". Ann. Rheum. Dis. 57 (3): 135–40. PMC 1752543. PMID 9640127.
  6. Moll JM, Haslock I, Macrae IF, Wright V (September 1974). "Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome". Medicine (Baltimore). 53 (5): 343–64. PMID 4604133.
  7. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, Stern RS, Feldman SR, Rolstad T (October 2005). "Epidemiology of psoriatic arthritis in the population of the United States". J. Am. Acad. Dermatol. 53 (4): 573. doi:10.1016/j.jaad.2005.03.046. PMID 16198775.
  8. 8.0 8.1 Hanova P, Pavelka K, Holcatova I, Pikhart H (August 2010). "Incidence and prevalence of psoriatic arthritis, ankylosing spondylitis, and reactive arthritis in the first descriptive population-based study in the Czech Republic". Scand. J. Rheumatol. 39 (4): 310–7. doi:10.3109/03009740903544212. PMID 20476864.
  9. Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE (May 2000). "The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991". J. Rheumatol. 27 (5): 1247–50. PMID 10813295.
  10. Moll JM, Wright V (May 1973). "Familial occurrence of psoriatic arthritis". Ann. Rheum. Dis. 32 (3): 181–201. PMC 1006078. PMID 4715537.
  11. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P (2005). "Psoriatic arthritis: epidemiology, clinical features, course, and outcome". Ann. Rheum. Dis. 64 Suppl 2: ii14–7. doi:10.1136/ard.2004.032482. PMC 1766874. PMID 15708927.
  12. Han C, Robinson DW, Hackett MV, Paramore LC, Fraeman KH, Bala MV (November 2006). "Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis". J. Rheumatol. 33 (11): 2167–72. PMID 16981296.
  13. Labitigan M, Bahče-Altuntas A, Kremer JM, Reed G, Greenberg JD, Jordan N, Putterman C, Broder A (April 2014). "Higher rates and clustering of abnormal lipids, obesity, and diabetes mellitus in psoriatic arthritis compared with rheumatoid arthritis". Arthritis Care Res (Hoboken). 66 (4): 600–7. doi:10.1002/acr.22185. PMC 3969762. PMID 24115739.
  14. Eder L, Wu Y, Chandran V, Cook R, Gladman DD (September 2016). "Incidence and predictors for cardiovascular events in patients with psoriatic arthritis". Ann. Rheum. Dis. 75 (9): 1680–6. doi:10.1136/annrheumdis-2015-207980. PMID 26493817.
  15. Rohekar S, Tom BD, Hassa A, Schentag CT, Farewell VT, Gladman DD (January 2008). "Prevalence of malignancy in psoriatic arthritis". Arthritis Rheum. 58 (1): 82–7. doi:10.1002/art.23185. PMID 18163513.
  16. McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD (May 2014). "Depression and anxiety in psoriatic disease: prevalence and associated factors". J. Rheumatol. 41 (5): 887–96. doi:10.3899/jrheum.130797. PMID 24692521.
  17. Ciacli C, Cojocaru M (2012). "Systemic osteoporosis--major complication of psoriatic arthritis". Rom J Intern Med. 50 (2): 173–8. PMID 23326962.
  18. Curtis JR, Beukelman T, Onofrei A, Cassell S, Greenberg JD, Kavanaugh A, Reed G, Strand V, Kremer JM (January 2010). "Elevated liver enzyme tests among patients with rheumatoid arthritis or psoriatic arthritis treated with methotrexate and/or leflunomide". Ann. Rheum. Dis. 69 (1): 43–7. doi:10.1136/ard.2008.101378. PMC 2794929. PMID 19147616.
  19. McLaughlin M, Ostör A (December 2014). "Early treatment of psoriatic arthritis improves prognosis". Practitioner. 258 (1777): 21–4, 3. PMID 25603589.
  20. Buckley C, Cavill C, Taylor G, Kay H, Waldron N, Korendowych E, McHugh N (October 2010). "Mortality in psoriatic arthritis - a single-center study from the UK". J. Rheumatol. 37 (10): 2141–4. doi:10.3899/jrheum.100034. PMID 20682670.
  21. Liu JT, Yeh HM, Liu SY, Chen KT (September 2014). "Psoriatic arthritis: Epidemiology, diagnosis, and treatment". World J Orthop. 5 (4): 537–43. doi:10.5312/wjo.v5.i4.537. PMC 4133459. PMID 25232529.
  22. WRIGHT V (December 1956). "Psoriasis and arthritis". Ann. Rheum. Dis. 15 (4): 348–56. PMC 1006908. PMID 13395269.
  23. 23.0 23.1 Punzi L, Pianon M, Rossini P, Schiavon F, Gambari PF (April 1999). "Clinical and laboratory manifestations of elderly onset psoriatic arthritis: a comparison with younger onset disease". Ann. Rheum. Dis. 58 (4): 226–9. PMC 1752862. PMID 10364901.
  24. Scarpa R, Cosentini E, Manguso F, Oriente A, Peluso R, Atteno M, Ayala F, D'Arienzo A, Oriente P (December 2003). "Clinical and genetic aspects of psoriatic arthritis "sine psoriasis"". J. Rheumatol. 30 (12): 2638–40. PMID 14719207.
  25. Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I, Walecki J (January 2013). "Psoriatic arthritis". Pol J Radiol. 78 (1): 7–17. doi:10.12659/PJR.883763. PMC 3596149. PMID 23493653.
  26. Krajewska-Włodarczyk M, Owczarczyk-Saczonek A, Placek W (2017). "Fatigue - an underestimated symptom in psoriatic arthritis". Reumatologia. 55 (3): 125–130. doi:10.5114/reum.2017.68911. PMC 5534506. PMID 28769135.
  27. Dhir V, Aggarwal A (April 2013). "Psoriatic arthritis: a critical review". Clin Rev Allergy Immunol. 44 (2): 141–8. doi:10.1007/s12016-012-8302-6. PMID 22294201.
  28. Moll JM, Wright V (1973). "Psoriatic arthritis". Semin. Arthritis Rheum. 3 (1): 55–78. PMID 4581554.
  29. Scarpa R, Peluso R, Atteno M (2007). "Clinical presentation of psoriatic arthritis". Reumatismo. 59 Suppl 1: 49–51. PMID 17828344.
  30. De Simone C, Guerriero C, Giampetruzzi AR, Costantini M, Di Gregorio F, Amerio P, Giampietruzzi AR (August 2003). "Achilles tendinitis in psoriasis: clinical and sonographic findings". J. Am. Acad. Dermatol. 49 (2): 217–22. PMID 12894068.
  31. Brockbank JE, Stein M, Schentag CT, Gladman DD (February 2005). "Dactylitis in psoriatic arthritis: a marker for disease severity?". Ann. Rheum. Dis. 64 (2): 188–90. doi:10.1136/ard.2003.018184. PMC 1755375. PMID 15271771.
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  35. Sobolewski P, Walecka I, Dopytalska K (2017). "Nail involvement in psoriatic arthritis". Reumatologia. 55 (3): 131–135. doi:10.5114/reum.2017.68912. PMC 5534507. PMID 28769136.
  36. Lai TL, Pang HT, Cheuk YY, Yip ML (August 2016). "Psoriatic nail involvement and its relationship with distal interphalangeal joint disease". Clin. Rheumatol. 35 (8): 2031–2037. doi:10.1007/s10067-016-3319-5. PMID 27251673.
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