Psoriatic Arthritis

2019 ◽  
pp. 157-160
Author(s):  
Kevin B. Hoover
Keyword(s):  
Psoriatic Arthritis ◽  
Treatment Efficacy ◽  
Imaging Modality ◽  
Axial Skeleton ◽  
Serologic Markers ◽  
Characteristic Imaging ◽  
Distal Interphalangeal ◽  
Joint Erosions ◽  
Criteria For Diagnosis ◽  
Nail Involvement

Chapter 33 discusses psoriatic arthritis, which is a seronegative spondyloarthropathy (SpA) affecting the peripheral and axial skeleton that may precede skin manifestations. Psoriatic arthritis is a challenging diagnosis because it often initially presents without psoriasis, lacks specific serologic markers, and resembles osteoarthritis and other inflammatory arthropathies. It is associated with joint erosions, destruction, and ankylosis often involving the distal interphalangeal (DIP) joints. Radiography is the primary imaging modality for initial diagnosis and monitoring disease progression and treatment efficacy. Skin and nail involvement and characteristic imaging findings are key criteria for diagnosis. MRI and US of symptomatic joints and/or MRI of the sacroiliac (SI) joints may be useful in clinically challenging cases.

scholarly journals Clinical Characteristics and Co-morbidities in Patients with Psoriatic Arthritis

2017 ◽  
Vol 15 (1) ◽  
pp. 39-43
Author(s):  
Buddhi Prasad Paudyal ◽  
M Gyawalee
Keyword(s):  
Psoriatic Arthritis ◽  
Inflammatory Arthritis ◽  
Fatty Liver Disease ◽  
Clinical Characteristics ◽  
Clinical Information ◽  
Medical Attention ◽  
Rheumatology Clinic ◽  
Distal Interphalangeal ◽  
Joint Arthritis ◽  
Nail Involvement

Introduction: Psoriatic Arthritis (PsA) is a chronic inflammatory arthritis and occurs in association with psoriasis, a chronic recurring and disfiguring skin disease. There is increasing recognition that both conditions are associated with multitude of co-morbidities.Objective: To delineate the clinical characteristics and co-morbidities in PsA patients attending a rheumatology clinic in Kathmandu valley.Material and Methods: Patients with already developed psoriasis who were seeking medical attention for arthritis during the period between January 2013 to December 2015 were prospectively enrolled. Patients were evaluated both by a dermatologist and a rheumatologist. A structured format was used to record relevant clinical information on psoriasis, PsA, and co-morbidities.Results: Among 55 patients with PsA, all were found to have plaque psoriasis mainly affecting extensor surfaces (64%), multiple areas (16%), and scalp (11%). Nail involvement was observed in 22% of patients. Symmetric polyarthritis was the most frequent (26%) form, followed by oligoarthrtis (18%), distal interphalangeal (DIP) joint arthritis (16%),spondyloarthritis (13%), and enthesitis-dactylitis (7%). Two thirds of patients were either overweight or obese. Almost half (47%) were current or past smokers. Diabetes or pre-diabetes was observed in 7% of cases. Hypertension, hyperlipidemia and ischemic heart disease (IHD) were present in 20%, 16%, and 5% respectively. Fatty liver disease was observed in 13% of the tested patients and 15% of patients were on some psychotropic drugs.Conclusion: Psoriasis with PsA was associated with both cardiovascular and non-cardiovascular co-morbidities. Doctors treating patients with these disorders should consider associated co-morbidities for better patient outcome.

Imaging of Erosive Osteoarthritis

2019 ◽  
pp. 200-202
Author(s):  
Daichi Hayashi ◽  
Ali Guermazi ◽  
Frank W. Roemer
Keyword(s):  
Differential Diagnosis ◽  
Psoriatic Arthritis ◽  
Imaging Modality ◽  
Joint Effusion ◽  
Imaging Features ◽  
Erosive Osteoarthritis ◽  
Characteristic Imaging ◽  
Radiographic Changes ◽  
Active Synovitis ◽  
Hand Radiography

Chapter 45 discusses imaging of erosive osteoarthritis (EOA), a severe phenotype of osteoarthritis (OA) characterized by erosions and superimposed synovitis, most typically seen in women in the interphalangeal (IP) joints of the hand. Radiography is the primary imaging modality used in the diagnosis of EOA. EOA is distinguished from non-EOA based on the presence of erosions on radiography. US and MRI can be useful in detecting erosions, joint effusion, and active synovitis that may precede radiographic changes. The most common differential diagnosis of EOA is psoriatic arthritis (PsA), which exhibits additional characteristic imaging features such as bony proliferations and periostitis.

scholarly journals AB0797 ULTRASONOGRAPHIC ASSESSMENT OF ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1698.2-1699
Author(s):  
I. Mahmoud ◽  
S. Rahmouni ◽  
A. Ben Tekaya ◽  
S. Bouden ◽  
R. Tekaya ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Achilles Tendon ◽  
Patellar Tendon ◽  
Clinical Examination ◽  
Disease Duration ◽  
Plantar Fascia ◽  
Quadriceps Tendon ◽  
The Mean ◽  
Triceps Tendon ◽  
Nail Involvement

Background:Entheseal involvement is a frequent and distinctive feature of psoriatic arthritis (PsA), often under diagnosed. It is especially associated with nail involvement. Because clinical examination is not sensitive enough for the detection of early signs of this involvement, US may be considered as an alternative imaging technique in the diagnosis of enthesopathy.Objectives:The aim of the present study is to evaluate US entheses abnormalities in PsA and their correlation with clinical characteristicsMethods:The study included patients diagnosed with PsA according to the CASPAR criteria. They underwent a thorough clinical examination with special regard to the presence of enthesitis using the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index.The US study bilaterally explored entheses at six sites: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar tendon insertion, distal quadriceps tendon and distal brachial triceps tendon. We evaluated the following elemental lesions of enthesis at each site: thickness and structure of the tendon, calcifications, bursae, erosions, power Doppler signal in bursa or enthesis full tendon.Results:Of the 33 patients, 39.4 % were male. The mean age was 51.2±12.5 years. The mean disease duration was 13.5±10.2 years.The mean DAPSA was 22.8± 19.7 [0.1-84.5]: remission(n=9), low activity (n=5),moderate activity (n=11),high activity(n=8).At inclusion, 11 patients (33.4%) patients presented with psoriatic onychopathy (45 fingernails) with a mean mNAPSI of 14.1±16. Out of the 528 entheseal sites, 92 were tender at the palpation (17,4%) with a mean SPARCC at 2.87.A total of 396 entheseal sites were examined by US. In 140 of them (35.35%), US found at least 1 sign indicative of enthesopathy. The most affected tendon was the distal Achilles tendon (42/396), followed by proximal plantar fascia (32/396), distal patellar tendon (20/396), quadriceps tendon (20/396), distal brachial triceps tendon(14/396) and finally proximal patellar tendon (12/396).The most common elemental lesions were enthsophytes (176), erosions (114) and calcifications (50).We found a positive correlation between age and both calcification (r=0,4, p=0.021) and enthesophytes (r=0.479, p=0.005).We found a positive correlation between enthesophyte and the tender and swollen joints count (r= 0.352, p=0.045, r=0.378, p=0.03) and the SPARCC score (r=0.397, p=0.022).Patients with higher BASDAI had thicker tendons (r=0.355, p=0.05).Patients with nail dystrophy had more bursitis and erosions.US scores did not correlate with sexe, disease duration and disease activity measures (ASDAS, DAPSA, DAS28 and PASI). Patients with subclinical entheseal involvement didn’t have higher inflammatory biomarkers (ESR, CRP).Conclusion:US subclinical enthesopthy are not rare in psoriatic arthritis, in particular in patients with active disease.Clinical nail involvement was associated with bursitis and erosions. New studies including larger study groups are required to verify the findings of the present studyDisclosure of Interests:None declared

scholarly journals SAT0025 Evolution of psoriatic arthritis with distal interphalangeal joints involvement at onset

2001 ◽  
Author(s):  
CA Montilla ◽  
CM González ◽  
FJ López-Longo ◽  
R Castillo ◽  
N Caro ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Distal Interphalangeal

scholarly journals Nail Involvement in Patients with Psoriatic Arthritis in Northern Iran

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
O. Zargari ◽  
E. Kazemnezhad Leyli ◽  
S. Z. Azimi
Keyword(s):  
Psoriatic Arthritis ◽  
Severe Disease ◽  
Cross Sectional Study ◽  
Joint Involvement ◽  
Sectional Study ◽  
Northern Iran ◽  
Cross Sectional ◽  
The Relationship ◽  
Nail Involvement

Background. Psoriatic arthritis (PsA) results in an increased burden of psoriasis and impairs both quality of life and an individual’s functional capacity. The relationship between nail involvement and PsA in psoriasis is not fully characterized. Aim. To evaluate the frequency and characteristics of nail involvement in psoriatic patients and to assess the relationship with joint involvement. Methods. A total of 197 patients with moderate-to-severe psoriasis were consecutively invited to participate in this cross-sectional study. The patients are divided into two groups: those with and those without psoriatic arthritis. Results. 69.5% of psoriatic (137 out of 197) patients had nail involvement. The most common nail abnormality was onycholysis, followed by pitting and oil droplet changes. Nail involvement was more common in patients with psoriatic arthritis (82.1% versus 57.8%, p=0.001). Conclusion. Nail involvement is commonly associated with PsA. Onycholysis, splinter hemorrhage, and oil drop were significantly more common in the PsA group as opposed to patients with just skin findings. In general, psoriatic patients with arthritis had more severe disease.

Radiological Assessment of Giant Cell Tumour of Bone in the Sacrum: From Diagnosis to Treatment Response Evaluation

2021 ◽  
Vol 17 ◽  
Author(s):  
Kirsten Van Langevelde ◽  
Niels Van Vucht ◽  
Shinji Tsukamoto ◽  
Andreas F. Mavrogenis ◽  
Costantino Errani
Keyword(s):  
Soft Tissue ◽  
Giant Cell ◽  
Giant Cell Tumour ◽  
Imaging Modality ◽  
Treatment Options ◽  
World Health Organisation ◽  
Axial Skeleton ◽  
Cell Tumour ◽  
World Health ◽  
Response Evaluation

: Giant cell tumour of bone (GCTB) typically occurs in young adults from 20-40 years old. Although the majority of lesions are located in the epi-metaphyses of the long bones, approximately one third of tumours is located in the axial skeleton, of which only 4% in the sacrum. Sacral tumours tend to be large at the time of presentation, and they present with aggressive features such as marked cortical destruction and an associated soft tissue component. The 2020 World Health Organisation classification of Soft Tissue and Bone Tumours describes GCTB as neoplasm which is locally aggressive and rarely metastasizing. The tumour contains three different cell types: neoplastic mononuclear stromal cells, macrophages and osteoclast-like giant cells. Two tumour subtypes were defined: conventional GCTB and malignant GCTB. Only 1-4% of GCTB is malignant. In this review article, we will discuss imaging findings at the time of diagnosis to guide the musculoskeletal radiologist in reporting these tumours. In addition, imaging for response evaluation after various treatment options will be addressed, such as surgery, radiotherapy, embolization and denosumab. Specific findings will be presented per imaging modality and illustrated by cases from our tertiary sarcoma referral center. Common postoperative and post radiotherapy findings in GCTB of the sacrum on MRI will be discussed.

PsART-ID inception cohort: clinical characteristics, treatment choices and outcomes of patients with psoriatic arthritis

Rheumatology ◽  
2020 ◽  
Author(s):  
Gizem Ayan ◽  
Sibel Zehra Aydin ◽  
Gezmis Kimyon ◽  
Cem Ozisler ◽  
Ilaria Tinazzi ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Characteristics ◽  
Life Experience ◽  
Real Life ◽  
Treatment Strategies ◽  
Inception Cohort ◽  
Disease Pattern ◽  
Involvement Rate ◽  
Axial Involvement ◽  
Nail Involvement

Abstract Objectives Our aim is to understand clinical characteristics, real-life treatment strategies, outcomes of early PsA patients and determine the differences between the inception and established PsA cohorts. Methods PsArt-ID (Psoriatic Arthritis- International Database) is a multicentre registry. From that registry, patients with a diagnosis of PsA up to 6 months were classified as the inception cohort (n==388). Two periods were identified for the established cohort: Patients with PsA diagnosis within 5–10 years (n = 328), ≥10 years (n = 326). Demographic, clinical characteristics, treatment strategies, outcomes were determined for the inception cohort and compared with the established cohorts. Results The mean (s.d.) age of the inception cohort was 44.7 (13.3) and 167/388 (43.0%) of the patients were male. Polyarticular and mono-oligoarticular presentations were comparable in the inception and established cohorts. Axial involvement rate was higher in the cohort of patients with PsA ≥10 years compared with the inception cohort (34.8% vs 27.7%). As well as dactylitis and nail involvement (P = 0.004, P = 0.001 respectively). Both enthesitis, deformity rates were lower in the inception cohort. Overall, 13% of patients in the inception group had a deformity. MTX was the most commonly prescribed treatment for all cohorts with 10.7% of the early PsA patients were given anti-TNF agents after 16 months. Conclusion The real-life experience in PsA patients showed no significant differences in the disease pattern rates except for the axial involvement. The dactylitis, nail involvement rates had increased significantly after 10 years from the diagnosis and the enthesitis, deformity had an increasing trend over time.

Psoriatic arthritis and chronic lymphoedema: treatment efficacy by adalimumab

2009 ◽  
Vol 28 (11) ◽  
pp. 1349-1350 ◽  
Author(s):  
Denise Tong ◽  
Sharron Eather ◽  
Nicholas Manolios
Keyword(s):  
Psoriatic Arthritis ◽  
Treatment Efficacy

Psoriatic Nail Dystrophy Is Associated with Erosive Disease in the Distal Interphalangeal Joints in Psoriatic Arthritis: A Retrospective Cohort Study

2019 ◽  
Vol 46 (9) ◽  
pp. 1097-1102 ◽  
Author(s):  
Anna S. Antony ◽  
Andrew Allard ◽  
Adwaye Rambojun ◽  
Christopher R. Lovell ◽  
Gavin Shaddick ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Joint Disease ◽  
Nail Dystrophy ◽  
Chi Square ◽  
Convenience Sample ◽  
Radiographic Damage ◽  
Erosive Disease ◽  
Distal Interphalangeal

Objective.To assess whether the association between psoriatic nail dystrophy and radiographic damage in the hands of patients with psoriatic arthritis (PsA) is specific to the distal interphalangeal (DIP) joints.Methods.A convenience sample of patients was collated from the Bath longitudinal PsA cohort. All patients had PsA according to the ClASsification for Psoriatic ARthritis criteria (CASPAR) criteria, scored radiographs of their hands, and documented nail scores as measured by the Psoriatic Nail Severity Score. Chi-square tests were performed to examine for association between features of nail dystrophy and radiographic damage in the DIP joints, and proximal interphalangeal or metacarpophalangeal (non-DIP) joints of the corresponding digits.Results.There were 134 patients included, with a median age of 53 years (interquartile range; IQR 44–61) and disease duration of 7 years (IQR 3–17). The presence of any form of psoriatic nail dystrophy was associated with erosion at the DIP joints of the corresponding digit (OR 1.9, 95% CI 1.23–2.83; p < 0.004) and this association was primarily driven by the presence of nail onycholysis (OR 1.72; 95% CI 1.12–2.62; p = 0.02). Nail subungual hyperkeratosis was more strongly associated with joint space narrowing, erosions, and osteoproliferation at the corresponding DIP joint compared to non-DIP joints (p < 0.001). Nail pitting was not associated with erosions or osteoproliferation.Conclusion.The presence of psoriatic nail dystrophy, particularly onycholysis, is associated with erosive disease at the DIP joints. Subungual hyperkeratosis is more strongly associated with erosive damage at the DIP than non-DIP joints. These findings support the anatomical and pathological link between nail and DIP joint disease.

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