1 / 20

Psoriatic arthritis

Psoriatic arthritis. DIP joint Involvement Nail changes. Psoriatic arthritis. Nail pitting in psoriatic arthritis. Psoriatic arthritis. Deforming arthritis. Psoriatic arthritis- pseudorheumatoid. Looks like RA But RF – psoriasis. What is this diagnosis?. Osteoarthritis.

hoshiko
Télécharger la présentation

Psoriatic arthritis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Psoriatic arthritis DIP joint Involvement Nail changes

  2. Psoriatic arthritis

  3. Nail pitting in psoriatic arthritis

  4. Psoriatic arthritis Deforming arthritis

  5. Psoriatic arthritis- pseudorheumatoid Looks like RA But RF – psoriasis

  6. What is this diagnosis? Osteoarthritis

  7. What is this diagnosis? Osteoarthritis

  8. Beware the rare but serious…. • Conditions that may present with inflammatory arthritis like RA • Polymyositis, dermatomyositis: should have muscle weakness, RF can be + low titre, do CK • Vasculitis eg Wegener’s granulomatosis: always do U/A, renal function, RF-, ANCA +, may be very resistant to usual RA therapy • Neoplastic conditions: resistant to usual RA therapy

  9. Case history 5 • 25 year old man, episode of diarrhoea, 3 weeks later onset of knee swelling, followed by ankle swelling and achilles tendonitis • Unable to walk in mornings due to pain and stiffness • By midday joints “warmed up” • No conjunctivitis, no dysuria, diarrhoea settled, no rash

  10. Investigations • FBC normal • ESR 53, CRP 36 • UEC normal • RF negative • ANA negative • Stool cultures- negative

  11. Clinical picture Left knee effusion

  12. Achilles tendonitis

  13. Diagnosis • Sero-negative inflammatory arthritis reactive arthritis • Think of this group if past history of diarrhoea (eg salmonlla), dysuria (eg chlamydia), sore throat (strep) • Typical joint distribution: lower limb asymmetrical, knee, ankle, enthesitis with achilles tendonitis, plantar fasciitis, sausage toes (dactylitis)

  14. Case history 6 • 35 year old man • 3 year history of low back, buttock pain • Worse in the morning, improves with walking around. • Wakes him in early hours of the morning • Past history of red eye many years ago, treated with steroid drops

  15. Examination and investigations • No peripheral joint synovitis • Back movements: some limitation of lumbar flexion, nil else • FBC normal • ESR, CRP normal • Diagnosis? • Further investigations?

  16. Diagnosis • Inflammatory back pain • Sero-negative spondyloarthropathy • Do pelvic Xray to look at sacro-iliac joints • HLA-B27 antigen • Not diagnostic test for ankylosing spondylitis • 10% normal population HLA-B27+ • 90% AS HLA-B27+

  17. Sacri-iliitis

  18. Psoriatic arthritis Ankylosing spondylitis subtype

  19. Joint distribution • Symmetrical, small joint arthritis, MCP, PIP, wrists, MTPs +/- other joints • Think RA, psoriatic, SLE or viral • Asymmetrical, predominantly lower limb, ankle knee, enthesitis • Think sero-negative spondyloarthropathies • Psoriatic, Reactive, ankylosing spondylitis • Sacro-iliac (buttock) pain, spinal stiffness • Think sero-negative spondyloarthropathies, eg ankylosing spondylitis

More Related