Nurse Talks Review Notes: Psoriatic Arthritis
Psoriatic Arthritis (PsA) is an inflammatory condition of the joints that has been associated to psoriasis (a long-term inflammatory skin condition). Around 10-20% of patients with Psoriasis develop PsA in a few years.
PsA is a type of arthritis that is under a group called Spondyloarthropathies. PsA is a seronegative spondyloarthopathy because a person with this condition is not positive for the rheumatoid factor, which makes it different to the rheumatoid arthritis type. Other examples of this spondyloarthropathies include Ankylosing Spondilitis and arthritis associated to inflammatory bowel disease.
Signs and Symptoms:
The signs and symptoms of PsA depends on severity and can be initially presented differently for each individual.
swollen joints
nail changes
dactylitis - inflammation of the finger due to inflammation of the joints
enthesitis - inflammation of a part of a tendon called the entheses, which are a point of insertion of the tendon to the bone.
Periostitis - inflammation of the periosteum of the bone
‘pencil-in-cup’ deformity in severe cases - this is a condition wherein a joint is seen in an x-ray as having a pencil and cup appearance meaning one joint appears pointed and the other is hollow-like in the shape of a cup.
arthritis mutilans - severe damage to the joints
onchylosis - separation of nail from nail bed
Psoriatic Arthritis: Michelle's Story
by NorthShore University HealthSystem (2019)
Factors associated to the development of PsA:
PsA is one of those diseases that is not completely understood however there are several factors that have been associated. These include:
Genetics
Environmental Factors such as exposure to stress or infection. Some people with PsA have exposures to streptococcus or HIV infections. In addition, joint trauma and drug use are also included under environmental factors.
Immunologic Factors (e.g. tumor necrosis factor alpha)
Onset
Usually around the age of 40 and above but it can occur at any age.
Pathophysiology of Psoriatic Arthritis
Psoriatic Arthritis - 3D Medical Animation
by AmerraMedical (2017)
The PEST Tool
The Psoriasis Epidemiological Screening Tool or PEST Tool is a tool used by clinicians to screen patients with PsA. This involves a series of questions that patients answer to give the clinician an idea about the patient’s arthritis history, joint pain and other relevant information. Diagnosing PsA is complicated as there are also other types of arthritis which also present with similar symptoms.
See link for more information:
Management of Psoriatic Arthritis
The management depends on the signs and symptoms as well as the severity and may involve:
Pain management (e.g. use of NSAIDs and other pain medications)
Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and sulfasalazine drugs (psoriatic-arthritis.com, 2021).
Anti-TNF medications such as infliximab
Disclaimer:
The content in this blog is for informational purposes only and should not be taken as medical advice. It is always best to consult your doctor for medical questions.
If you are a healthcare provider, the content here should not be used to make any diagnosis, give advice or prescribe treatment as this blog is for informational and educational purposes only. Healthcare is an everchanging field and each patient is unique. It is your responsibility as a healthcare provider to always refer to current care standards and practices.
References:
AmerraMedical, 2017. Psoriatic Arthritis - 3D Medical Animation. [video] Available at: <https://www.youtube.com/watch?v=CvFNdHkwAk4>
Krueger JG, Bowcock A. (2005). Psoriasis pathophysiology: current concepts of pathogenesisAnnals of the Rheumatic Diseases 2005;64:ii30-ii36.
National Psoriasis Foundation, (2021). [online] Available at: <https://www.psoriasis.org/psoriatic-arthritis-screening-test/>
NorthShore University HealthSystem, 2019. Psoriatic Arthritis: Michelle's Story. [video] Available at: <https://www.youtube.com/watch?v=OA6Fk-GDFdo>
Psoriatic-Arthritis.Org, (2016). Traditional DMARDs for Psoriatic Arthritis | Psoriatic-Arthritis.com. [online] Psoriatic-Arthritis.com. Available at: <https://psoriatic-arthritis.com/medications/traditional-dmards-how-well-works-side-effects>
Psoriasis-Association.Org, (2018). About Psoriatic Arthritis. [online] Psoriasis Association. Available at: <https://www.psoriasis-association.org.uk/about-psoriatic-arthritis?gclid=Cj0KCQjw8p2MBhCiARIsADDUFVG8Do5FLOk-broYlSnCoue07uetdixh7a3h0yGbpIv8ycf1Hfl9I44aAvXLEALw_wcB> [Accessed 7 November 2021].