Joint problems in Patients with Psoriasis

Anything which might be useful to acquire knowledge, whether for the Swiss Board Exam (FMH) or CME (Continuing Medical Education)

Joint problems in Patients with Psoriasis

Postby CFH » Fri Jul 31, 2015 11:35 am

Think of Psoriatric Arthritis ! (PsA) (differential diagnosis: osteoarthritis, gout, Crohn’s disease)

Caracteristics of Psoriasis Arthritis
-affects individuals between 30 and 50 years old. It is due to overexpression of TNFalpha in the joints.
–skin lesions of Psoriasis (P) appear 5 to 10 years before PsA in in 70% of patients. That means that the dermatologist will be at the forefront to detect PsA.
-PsA preceeds P by 10 15 years 10% of the time
–P is accompanied by PsA 10-15% of the time (In Europe the association seems to occur less than 5%)
-All in all quality of life is severely impaired

What are the clinical features of Psoriatric Arthritis ?

asymmetrical oligoarthritis :

present in 14-70% of PsA- predominantly in females
usually affects the knee, elbow or shoulder. It can be difficult to detect when symmetrical

DIP joint arthritis (Distal Interphalyngeal Joint)

present in 1-16% of patients with PsA
More specific of PsA than the other inflammatory arthritis


painful swelling
also called sausage digit: on fingers. But it can occur on the toes (so don’t forget to ask the patient to take the shoes off !)


inflammation of the tendon or ligament which attaches to the joint capsule/bone
often affects the patella and achilles tendon (again take the shoes off !)

-Arhtritis Mutilans: the end result of PsA where the joints are destroyed irreversibly….it occurs in 5% of patients with PsA

-…in addition to the joints, there is often muscle pain (Myalgia) which is often mistaken for fibromyalgia

Feature of PsA on imaging (Radiography): “pencil cup” deformity

How about the Nail changes in Plaque Psoriasis: are they helpful in identifying PsA ?

Nail characteristics in psoriasis (pitting, onycholysis, subungual hyperkeratosis…):
The association between nail involvement and PsA is not statistically significant

Psoriatic arthritis for the dermatologist. Alan Menter (United States). SY31 – Clinical Aspects of Psoriasis, Including Co-Morbidities. World Congress of Dermatology 2015 – Vancouver, Canada

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