|
|
| (149 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{SI}}
| | |
| {{CMG}}; {{CK}} | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| ==Overview==
| |
|
| |
|
| ==Historical Perspective==
| | {{Psoriatic arthritis}} |
| *[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
| | {{CMG}}; {{AE}} {{CK}} |
| *In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
| |
| *In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
| |
|
| |
| ==Classification==
| |
| *[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
| |
| :*[group1]
| |
| :*[group2]
| |
| :*[group3]
| |
| *Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
| |
|
| |
| ==Pathophysiology==
| |
| *The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
| |
| *The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
| |
| *On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
| |
| *On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
| |
|
| |
| ==Clinical Features==
| |
|
| |
|
| ==Differentiating [disease name] from other Diseases== | | ==[[Psoriatic arthritis overview|Overview]]== |
| *[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
| |
| :*[Differential dx1]
| |
| :*[Differential dx2]
| |
| :*[Differential dx3]
| |
|
| |
| ==Epidemiology and Demographics==
| |
| * The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
| |
| * In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
| |
|
| |
| ===Age===
| |
| *Patients of all age groups may develop [disease name].
| |
|
| |
| *[Disease name] is more commonly observed among patients aged [age range] years old.
| |
| *[Disease name] is more commonly observed among [elderly patients/young patients/children].
| |
|
| |
| ===Gender===
| |
| * In general, there is no gender predilection to psoriatic arthritis.
| |
|
| |
|
| ===Race=== | | ==[[Psoriatic arthritis historical perspective|Historical Perspective]]== |
| *There is no racial predilection for [disease name].
| |
|
| |
| *[Disease name] usually affects individuals of the [race 1] race.
| |
| *[Race 2] individuals are less likely to develop [disease name].
| |
|
| |
| ==Risk Factors==
| |
| *Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
| |
|
| |
| == Natural History, Complications and Prognosis==
| |
| *The majority of patients with [disease name] remain asymptomatic for [duration/years].
| |
| *Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
| |
| *If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
| |
| *Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
| |
| *Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
| |
|
| |
| == Diagnosis ==
| |
| ===Diagnostic Criteria===
| |
| *The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
| |
| :*[criterion 1]
| |
| :*[criterion 2]
| |
| :*[criterion 3]
| |
| :*[criterion 4]
| |
|
| |
| === Symptoms ===
| |
| *[Disease name] is usually asymptomatic.
| |
| *Symptoms of [disease name] may include the following:
| |
| :*[symptom 1]
| |
| :*[symptom 2]
| |
| :*[symptom 3]
| |
| :*[symptom 4]
| |
| :*[symptom 5]
| |
| :*[symptom 6]
| |
|
| |
| === Physical Examination ===
| |
| *Patients with [disease name] usually appear [general appearance].
| |
| *Physical examination may be remarkable for:
| |
| :*[finding 1]
| |
| :*[finding 2]
| |
| :*[finding 3]
| |
| :*[finding 4]
| |
| :*[finding 5]
| |
| :*[finding 6]
| |
|
| |
| === Laboratory Findings ===
| |
| *There are no specific [[Medical laboratory|laboratory]] findings associated with [[Psoriatic arthritis (patient information)|psoriatic arthritis]] and most the tests are non-specific.
| |
| *However, there are certain [[Medical laboratory|laboratory]] tests that can check for markers of [[inflammation]] and to exclude other [[Disease|diseases]]. These include:<ref name="pmid17828345">{{cite journal |vauthors=Punzi L, Podswiadek M, Oliviero F, Lonigro A, Modesti V, Ramonda R, Todesco S |title=Laboratory findings in psoriatic arthritis |journal=Reumatismo |volume=59 Suppl 1 |issue= |pages=52–5 |date=2007 |pmid=17828345 |doi= |url=}}</ref>
| |
| ** [[Complete blood count|CBC]] with differential count
| |
| *** [[Leukocytosis]]
| |
| *** [[Anemia|Anaemia]]
| |
| ** Elevated [[Erythrocyte sedimentation rate|ESR]]
| |
| ** Elevated [[C-reactive protein|CRP]] (C- reactive protein)
| |
| ** [[Autoantibody|Autoantibodies]]: The following [[Autoantibody|autoantibodies]] may be found in patients with [[Psoriatic arthritis (patient information)|psoriatic arthritis]].<ref name="pmid15834057">{{cite journal |vauthors=Johnson SR, Schentag CT, Gladman DD |title=Autoantibodies in biological agent naive patients with psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=64 |issue=5 |pages=770–2 |date=May 2005 |pmid=15834057 |pmc=1755477 |doi=10.1136/ard.2004.031286 |url=}}</ref>
| |
| *** [[Rheumatoid factor]]
| |
| *** [[Antinuclear antibodies|ANA]] ([[Antinuclear antibodies]])
| |
| *** Anti-citrullinated peptide antibodies (ACPA)
| |
| ** Genetic markers:<ref name="pmid23916976">{{cite journal |vauthors=Chandran V, Bull SB, Pellett FJ, Ayearst R, Rahman P, Gladman DD |title=Human leukocyte antigen alleles and susceptibility to psoriatic arthritis |journal=Hum. Immunol. |volume=74 |issue=10 |pages=1333–8 |date=October 2013 |pmid=23916976 |doi=10.1016/j.humimm.2013.07.014 |url=}}</ref><ref name="pmid21900282">{{cite journal |vauthors=Eder L, Chandran V, Pellet F, Shanmugarajah S, Rosen CF, Bull SB, Gladman DD |title=Human leucocyte antigen risk alleles for psoriatic arthritis among patients with psoriasis |journal=Ann. Rheum. Dis. |volume=71 |issue=1 |pages=50–5 |date=January 2012 |pmid=21900282 |doi=10.1136/ard.2011.155044 |url=}}</ref>
| |
| *** [[HLA-B27]]
| |
| *** [[HLA-C]]*06
| |
| ** [[Synovial fluid]] analysis: Elevated [[White blood cells|WBC]] count suggestive of [[inflammation]].
| |
|
| |
|
| ===Imaging Findings=== | | ==[[Psoriatic arthritis classification|Classification]]== |
| * [[X-rays|X-ray]] of digits:<ref name="pmid25231177">{{cite journal |vauthors=McGonagle D, Hermann KG, Tan AL |title=Differentiation between osteoarthritis and psoriatic arthritis: implications for pathogenesis and treatment in the biologic therapy era |journal=Rheumatology (Oxford) |volume=54 |issue=1 |pages=29–38 |date=January 2015 |pmid=25231177 |pmc=4269795 |doi=10.1093/rheumatology/keu328 |url=}}</ref><ref name="pmid16126794">{{cite journal |vauthors=Siannis F, Farewell VT, Cook RJ, Schentag CT, Gladman DD |title=Clinical and radiological damage in psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=65 |issue=4 |pages=478–81 |date=April 2006 |pmid=16126794 |pmc=1798082 |doi=10.1136/ard.2005.039826 |url=}}</ref><ref name="pmid23430715">{{cite journal |vauthors=Haddad A, Chandran V |title=Arthritis mutilans |journal=Curr Rheumatol Rep |volume=15 |issue=4 |pages=321 |year=2013 |pmid=23430715 |doi=10.1007/s11926-013-0321-7 |url=}}</ref>
| |
| ** Bone destructive changes including formation of subchondral cyst and erosions
| |
| ** Fluffy periostitis
| |
| ** [[Ankylosis]]
| |
| ** [[Phalanx bones|Phalangeal]] tuft [[acroosteolysis]]
| |
| ** New [[bone]] formation: Perisoteal and endosteal [[bone]] formation may result in increased [[bone density]] of an entire phalanx resulting in so called ivory phalanx.
| |
| ** Pencil-in-cup deformity (osteolytic lesions) usually involving [[Interphalangeal articulations of hand|DIP joints]] but also affects [[Interphalangeal articulations of hand|PIP joints]]
| |
| ** [[Osteolysis]] and [[ankylosis]] both coexists in the same [[Joint|joints]] of [[Hand|hands]] and [[foot]]
| |
| ** [[Enthesopathy|Enthesitis]]
| |
| ** [[Dactylitis]] (sausage digit)
| |
| ** Gross finger [[deformity]]
| |
| ** [[Arthritis]] mutilans: It may lead to "telescoping of fingers" caused by marked bony resorption and the subsequent collapse of soft tissue
| |
| ** Asymmetrical [[sacroiliitis]]
| |
| ** [[Spondylitis]]: Asymmetric paravertebral ossifications and relative sparing of the facet joints
| |
| [[File:Psoriatic-arthritis of hands.jpg|centre|thumb|Psoriatic-arthritis of hands showing pencil-in-cup deformity - By Case courtesy of Dr Jeremy Jones, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8798">rID: 8798</a>]]
| |
|
| |
|
| *MRI:
| | ==[[Psoriatic arthritis pathophysiology|Pathophysiology]]== |
|
| |
|
| === Other Diagnostic Studies === | | ==[[Psoriatic arthritis causes|Causes]]== |
| * [[Bone mineral density]] (BMD) testing: [[Bone density]] may decreased in psoriatic arthritis resulting in [[osteoporosis]] and increased risk for [[Bone fracture|fractures]]. <ref name="pmid11196516">{{cite journal |vauthors=Frediani B, Allegri A, Falsetti P, Storri L, Bisogno S, Baldi F, Filipponi P, Marcolongo R |title=Bone mineral density in patients with psoriatic arthritis |journal=J. Rheumatol. |volume=28 |issue=1 |pages=138–43 |date=January 2001 |pmid=11196516 |doi= |url=}}</ref>
| |
|
| |
|
| == Treatment == | | ==[[Psoriatic arthritis differential diagnosis|Differentiating Psoriatic arthritis from Other Diseases]]== |
| === Medical Therapy ===
| |
| * Medical therapy for [[psoriatic arthritis]] is according to the guidelines proposed by
| |
| ** European League Against Rheumatism (EULAR): Guidelines were first proposed in 2012 and they were updated in 2015.<ref name="pmid26644232">{{cite journal |vauthors=Gossec L, Smolen JS, Ramiro S, de Wit M, Cutolo M, Dougados M, Emery P, Landewé R, Oliver S, Aletaha D, Betteridge N, Braun J, Burmester G, Cañete JD, Damjanov N, FitzGerald O, Haglund E, Helliwell P, Kvien TK, Lories R, Luger T, Maccarone M, Marzo-Ortega H, McGonagle D, McInnes IB, Olivieri I, Pavelka K, Schett G, Sieper J, van den Bosch F, Veale DJ, Wollenhaupt J, Zink A, van der Heijde D |title=European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update |journal=Ann. Rheum. Dis. |volume=75 |issue=3 |pages=499–510 |date=March 2016 |pmid=26644232 |doi=10.1136/annrheumdis-2015-208337 |url=}}</ref><ref name="pmid21953336">{{cite journal |vauthors=Gossec L, Smolen JS, Gaujoux-Viala C, Ash Z, Marzo-Ortega H, van der Heijde D, FitzGerald O, Aletaha D, Balint P, Boumpas D, Braun J, Breedveld FC, Burmester G, Cañete JD, de Wit M, Dagfinrud H, de Vlam K, Dougados M, Helliwell P, Kavanaugh A, Kvien TK, Landewé R, Luger T, Maccarone M, McGonagle D, McHugh N, McInnes IB, Ritchlin C, Sieper J, Tak PP, Valesini G, Vencovsky J, Winthrop KL, Zink A, Emery P |title=European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies |journal=Ann. Rheum. Dis. |volume=71 |issue=1 |pages=4–12 |date=January 2012 |pmid=21953336 |doi=10.1136/annrheumdis-2011-200350 |url=}}</ref>
| |
| ** Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)<ref name="pmid18952643">{{cite journal |vauthors=Ritchlin CT, Kavanaugh A, Gladman DD, Mease PJ, Helliwell P, Boehncke WH, de Vlam K, Fiorentino D, Fitzgerald O, Gottlieb AB, McHugh NJ, Nash P, Qureshi AA, Soriano ER, Taylor WJ |title=Treatment recommendations for psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=68 |issue=9 |pages=1387–94 |date=September 2009 |pmid=18952643 |pmc=2719080 |doi=10.1136/ard.2008.094946 |url=}}</ref>
| |
| ** American College of Rheumatology (ACR)
| |
| ** National Psoriasis Foundation (NPF)
| |
| ** American Academy of Dermatology (AAD) Psoriasis Guidelines of Care<ref name="pmid21306785">{{cite journal |vauthors=Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R |title=Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions |journal=J. Am. Acad. Dermatol. |volume=65 |issue=1 |pages=137–74 |date=July 2011 |pmid=21306785 |doi=10.1016/j.jaad.2010.11.055 |url=}}</ref>
| |
| ** British Society of Rheumatology (BSR)<ref name="pmid23887065">{{cite journal |vauthors=Coates LC, Tillett W, Chandler D, Helliwell PS, Korendowych E, Kyle S, McInnes IB, Oliver S, Ormerod A, Smith C, Symmons D, Waldron N, McHugh NJ |title=The 2012 BSR and BHPR guideline for the treatment of psoriatic arthritis with biologics |journal=Rheumatology (Oxford) |volume=52 |issue=10 |pages=1754–7 |date=October 2013 |pmid=23887065 |doi=10.1093/rheumatology/ket187 |url=}}</ref>
| |
| * Pharmacologic therapy for [[psoriatic arthritis]] include, [[Non-steroidal anti-inflammatory drug|Nonsteroidal anti-inflammatory drugs]] ([[Non-steroidal anti-inflammatory drug|NSAID]]<nowiki/>s), conventional synthetic [[Disease-modifying antirheumatic drug|DMARDs]] (eg, [[methotrexate]], [[sulfasalazine]], [[Cyclosporine|cyclosporin A]], [[leflunomide]]), biologic[[Disease-modifying antirheumatic drug|DMARD]]<nowiki/>s<nowiki/> (eg, [[TNF inhibitor|TNF inhibitors]] ([[etanercept]], [[infliximab]], [[adalimumab]], [[golimumab]]), [[Phosphodiesterase inhibitors|phosphodiesterase (PDE) inhibitors]] ([[apremilast]]), interleukin(IL) inhibitors ([[secukinumab]], [[ixekizumab]]), [[abatacept]]) and [[Joint|intraarticular]] [[Glucocorticoids|glucocorticoid]] injections.
| |
| * '''Peripheral [[arthritis]]''':
| |
| ** '''Mild disease''': [[Non-steroidal anti-inflammatory drug|Nonsteroidal antiinflammatory drugs]] ([[Non-steroidal anti-inflammatory drug|NSAID]]<nowiki/>s) are the most preferred for the management of mild active [[psoriatic arthritis]].
| |
| *** Preferred regimen (1): Naproxen: 375-500 mg / twice a day
| |
| *** Preferred regimen (2): Celecoxib: 200 mg / twice a day
| |
| *** Preferred regimen (4): Nimesulide 200 and 400 mg/day
| |
| *** Preferred regimen (3): Ibuprofen: Max dose of up to 2400 mg / day
| |
| **** Adverese effects of [[Non-steroidal anti-inflammatory drug|Nonsteroidal antiinflammatory drugs]] include increased cardiovascular risk, gastritis, ulcers and low renal clearance.
| |
|
| |
|
| * '''Non pharmacologic therapy''':
| | ==[[Psoriatic arthritis epidemiology and demographics|Epidemiology and Demographics]]== |
| ** [[Physical exercise|Exercise]]
| |
| ** [[Weight]] reduction
| |
| ** [[Physical therapy]]
| |
| ** Educating the [[patient]] about [[disease]] course, [[joint]] protection and [[Comorbidity|comorbid]] conditions.
| |
| ** [[Orthotics]]
| |
|
| |
|
| === Surgery === | | ==[[Psoriatic arthritis risk factors|Risk Factors]]== |
| *Surgery is the mainstay of therapy for [disease name].
| |
| *[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
| |
| *[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
| |
|
| |
| === Prevention ===
| |
| *There are no primary preventive measures available for [disease name].
| |
|
| |
| *Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
| |
|
| |
|
| *Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
| | ==[[Psoriatic arthritis screening|Screening]]== |
|
| |
|
| ==References== | | ==[[Psoriatic arthritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| {{Reflist|2}}
| |
|
| |
| [[Category:Pick One of 28 Approved]] | |
|
| |
|
| | ==Diagnosis== |
| | [[Psoriatic arthritis diagnostic study of choice |Diagnostic study of choice]] | [[Psoriatic arthritis history and symptoms|History and Symptoms]] | [[Psoriatic arthritis physical examination|Physical Examination]] | [[Psoriatic arthritis laboratory tests|Laboratory Findings]] | [[Psoriatic arthritis electrocardiogram|Electrocardiogram]] | [[Rheumatoid arthritis x ray|X ray]] | [[Rheumatoid arthritis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Psoriatic arthritis CT|CT]] | [[Psoriatic arthritis MRI|MRI Findings]] | [[Psoriatic arthritis other imaging findings|Other Imaging Findings]] | [[Psoriatic arthritis other diagnostic studies|Other Diagnostic Studies]] |
| | |
| | ==Treatment== |
| | [[Psoriatic arthritis medical therapy|Medical Therapy]] | [[Psoriatic arthritis surgical therapy|Surgical Therapy]] | [[Psoriatic arthritis Primary prevention|Primary prevention]] | [[Psoriatic arthritis secondary prevention|Secondary prevention]] | [[Psoriatic arthritis future or investigational therapies|Future or Investigational Therapies]] |
| | |
| | ==Case Studies== |
| | :[[Psoriatic arthritis case study 1|Case #1]] |
| | |
| | ==Related Chapters== |
| | |
| | |
| | {{Diseases of the musculoskeletal system and connective tissue}} |
| | {{WH}} |
| {{WS}} | | {{WS}} |
| {{WH}}
| | e)|adverse effects]] and associated [[Comorbidity|comorbid conditions]]. |
| | |
| | [[Category:Arthritis]] |
| | [[Category:Autoimmune diseases]] |
| | [[Category:Rheumatology]] |