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    Psoriasis & Psoriatic Arthritis: DR Prathibha J P

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    jeffery
    Psoriasis and psoriatic arthritis are chronic inflammatory disorders that affect the skin and joints. Key points: - Psoriasis causes rapid skin cell growth resulting in thick patches of red sores covered in scales. Joints can become inflamed and painful. - Psoriatic arthritis ranges from mild nondestructive disease to severe destruction. It commonly affects fingers, toes, spine. - Diagnosis is based on skin/nail changes, joint symptoms, and radiological evidence of bone erosion and new bone formation near joints. Early treatment with medications can prevent long-term joint damage.

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    Psoriasis & Psoriatic Arthritis: DR Prathibha J P

    Uploaded by

    jeffery
    22 views48 pages
    Psoriasis and psoriatic arthritis are chronic inflammatory disorders that affect the skin and joints. Key points: - Psoriasis causes rapid skin cell growth resulting in thick patches of red sores covered in scales. Joints can become inflamed and painful. - Psoriatic arthritis ranges from mild nondestructive disease to severe destruction. It commonly affects fingers, toes, spine. - Diagnosis is based on skin/nail changes, joint symptoms, and radiological evidence of bone erosion and new bone formation near joints. Early treatment with medications can prevent long-term joint damage.

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    Psoriasis and psoriatic arthritis are chronic inflammatory disorders that affect the skin and joints. Key points: - Psoriasis causes rapid skin cell growth resulting in thick patches of red sores covered in scales. Joints can become inflamed and painful. - Psoriatic arthritis ranges from mild nondestructive disease to severe destruction. It commonly affects fingers, toes, spine. - Diagnosis is based on skin/nail changes, joint symptoms, and radiological evidence of bone erosion and new bone formation near joints. Early treatment with medications can prevent long-term joint damage.

    Copyright:

    © All Rights Reserved
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    22 views48 pages

    Psoriasis & Psoriatic Arthritis: DR Prathibha J P

    Uploaded by

    jeffery
    Psoriasis and psoriatic arthritis are chronic inflammatory disorders that affect the skin and joints. Key points: - Psoriasis causes rapid skin cell growth resulting in thick patches of red sores covered in scales. Joints can become inflamed and painful. - Psoriatic arthritis ranges from mild nondestructive disease to severe destruction. It commonly affects fingers, toes, spine. - Diagnosis is based on skin/nail changes, joint symptoms, and radiological evidence of bone erosion and new bone formation near joints. Early treatment with medications can prevent long-term joint damage.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 48

    Psoriasis & Psoriatic Arthritis

    Dr Prathibha J P
    Psoriasis
    • Chronic progressive, inflammatory disorder of
    the Skin and Joints
    • Fingernails and toenails are also affected
    • Individuals with psoriasis may suffer from
    depression and low self-esteem
    Aetiopathogenisis
    • Not Known
    • Multifactorial inheritance
    • Genetic predisposition:
    HLA-B13, B17, and Cw6
    • Epidermal hyperproliferation
    • Angiogenesis
    • Overexpression of Th1 cytokines such as IL 2, IL 6, IL 8,
    IL 12, INF - γ, TNF α
    • Skin cells replicate at an extremely rapid rate.
    • New skin cells are produced about eight times
    faster than normal--over several days instead
    of a month.
    • Forming thick patches, or plaques, of red sores
    (lesions) covered with flaky, silvery-white dead
    skin cells (scales)
    • Sex: Adults (M=F) but in adolescents (F>M)
    • Age: 2 peak age ranges
    1st peak : 16-22 years
    2nd peak: 57-60 years
    • Earlier age of onset: Positive family history
    Triggering factor
    • Trauma: Mechanical, Chemical
    • Infections: Streptococcus, HIV
    • Stress
    • Excessive alcohol consumption
    • Smoking
    • Metabolic Factors: Pregnancy, hypocalcemia
    • Drugs - lithium, Beta-blockers, ACE inhibitors,
    Antimalarials, Captopril, Withdrawal of
    corticosteroids
    Psoriasis
    • Classical Lesion: Erythematous, round to oval well
    defined scaly plaques with sharply demarcated
    borders
    • Scales: Psoriatic plaques typically have a dry, thin,
    silvery-white or micaceous scale.
    • Sites: Elbows, knees, extensors of extremities, scalp
    & sacral region in a symmetric pattern.
    • Palms/ soles involved commonly
    • New lesions appearing at sites of
    injury/trauma to the skin (Koebner
    phenomenon)
    • Exacerbation in winter, improvement in
    summer
    • Significant joint pain, stiffness, deformity in 10-
    20%
    • Auspitz sign:
    Removing the scale reveals a smooth, red,
    glossy membrane with tiny punctate bleeding
    points
    • Koebner’s phenomenon
    Linear distribution of the plaques seen along
    scratch marks or at sites of trauma
    Auzpits sign Koebner’s phenomena
    Morphological types
    • Chronic plaque psoriasis: plaques with less scaling
    • Guttate psoriasis: Common in children , good prognosis
    • Pustular psoriasis: Crops of pustules based on erythema
    – Localised / generalised
    – Impetigo herpetiformis(Pregnancy asso., Psoriasis)
    • Erythrodermic psoriasis: 16-24% of all cases of exfoliative
    dermatitis
    • Linear psoriasis: linear arrangement of plaques
    Distributional variation
    • Scalp psoriasis
    • Palmoplantar psoriasis
    • Nail psoriasis: pitting, onycholysis, subungual
    hyperkeratosis, or the oil-drop sign. (25-50%)
    • Inverse psoriasis/Flexural Psoriasis:
    – spares the typical extensor surfaces

    – affects intertriginous (i.e, axillae, inguinal folds,


    inframammary creases) areas with minimal scaling.
    Guttate Psoriasis
    Pustular Psoriasis
    Impetigo Herpetiformis
    Erythrodermic Psoriasis
    Linear Psoriasis
    Scalp Psoriasis
    Inverse/Flexural Psoriasis
    Palmoplantar Psoriasis
    Nail Psoriasis
    • Psoriasis can affect both fingernails and
    toenails. Commonly seen in fingernails
    • Skin + nail involvement 50%.
    • In psoriatic arthritis this may rise to 80%.
    • Fingernails are more often involved than
    toenails.
    • For many people, nail psoriasis is often mild
    and causes few problem
    Common changes in Nail psoriasis
    • Pitting of the nails – the surface of the nail develops small
    pits(Thimble Nails)>20 pits/nail
    • Onycholysis – the nail becomes detached from the underlying nail bed
    • Subungual hyperkeratosis – a chalky substance accumulates under
    the nail. The nail becomes raised and can become tender
    • Discolouration – yellow brown discoloration of nail
    • Oil drop/ Salmon Patch - red discoloration in nail bed proximal to
    onycholysis
    • Bues Lines – Transverse ridges on nail
    • Psoriatic inflammation nail Matrix – nail crumpling
    • Splinter haemorrhages
    • Red lunula
    Oil drop sign Subungual hyperkeratosis
    Nail Psoriasis
    Pitting of nails Crumpling of nails
    Clinical Presentation
    • 60 – 70%: Skin psoriasis
    • 15%: Psoriatic arthritis
    • 15%: Skin and arthritis diagnosed at same time
    Psoriatic Arthritis
    Psoriatic Arthritis
    • Chronic progressive, inflammatory disorder of the
    joints
    – Characterized by osteolysis and bony proliferation
    • Males and females are equally affected
    • Usually seronegative for Rheumatoid Factor
    • Classified with HLA-B27-associated
    spondyloarthropathies
    • PsA can range from mild nondestructive disease to a
    severely rapid and destructive arthropathy
    Psoriatic Arthritis
    • Seen in 5-10% of psoriatic patients
    • Types:
    1. Classic (16%)-DIP joint involvement
    2. Oligoarticular (70%)< 5joints, asymmetric
    3. Rheumatoid type(15%)>5joints, symmetric
    4. Psoriatic spondylitis (5%)
    5. Arthritis mutilans (5%)
    • Enthesitis (inflammation at site of tendon
    insertion)
    • Tenosynovitis (inflammation of tendon and its
    enveloping sheath)
    • Dactylitis or “sausage digit”
    • Morning stiffness lasting >30 min in 50% of
    patients
    • Ridging, pitting of nails, onycholysis
    • Dactylitis noted in >40% of patients
    • Eye inflammation (conjunctivitis, iritis, or
    uveitis)
    Extra articular findings
    • Skin - psoriasis
    • Nails - pits and onycholysis
    • Pitting edema - often asymmetrical
    • Ocular inflammation - conjunctivitis, iritis
    • Inflammatory Bowel disease
    Hallmark of Ps A
    Radiological findings
    • Narrowed joint space and condylar erosions
    • Reactive subperiosteal new bone
    formation(juxta-articular)
    • Pencil in cup apperance
    Differentials
    • Rheumatoid Arthritis
    • Reactive arthritis
    • Ankylosing Spondylitis
    How to diagnose Ps A
    • No diagnostic laboratory testing
    • Radiologically:
    – erosive changes and new bone formation in distal
    joints
    – Fluffy periostitis and new bone formation at sites
    of enthesitis
    – “pencil in cup” appearance
    CASPAR Criteria for Diagnosis PsA
    • Inflammatory articular disease (joint, spine, or
    entheseal)
    • With 3 points from following categories:
    − Psoriasis: current (2), history (1), family history (1)
    − Nail dystrophy (1)
    − Negative rheumatoid factor (1)
    − Dactylitis: current (1), history (1) recorded by a rheumatologist
    − Radiographs: (hand/foot) evidence of juxta-articular new bone
    formation
    • Specificity 98.7%, Sensitivity 91.4%
    Features of PsA
    Treatment
    • NSAIDs if disease is mild.
    • PT, OT, splinting devices
    • If erosive disease, treat aggressively with
    DMARDs (MTX, Sulfasalazine, CsA).
    • Early referral to rheumatology for initiation of
    DMARDs to prevent progression
    Prognosis
    • 20% of patients have a severe an debilitating
    form of arthritis
    • progression of clinical damage occurs in a
    majority of patients
    • radiologic changes occur over time despite
    treatment
    Thank You

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