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__NOTOC__
__NOTOC__
{{Xyz}}
{{Psoriatic arthritis}}
 
{{CMG}}; {{AE}} {{CK}}
{{CMG}}; {{AE}}


==Overview==
==Overview==
Line 30: Line 29:


===Vital Signs===
===Vital Signs===
 
*Vital signs of patients with psoriatic arthritis are usually within normal limits.
*Vital signs of patients with psoriatic arthritis are usually with in normal limits.


===Skin===
===Skin===
 
* Psoriatic arthritis may occur after the onset of [[psoriasis]] in most of the [[Patient|patients]]. However, in some cases, [[arthritis]] precede [[psoriasis]]. The phenotypes of skin [[psoriasis]] that are  associated with an increased risk of psoriatic arthritis are the lesions in the [[scalp]], [[Nail (anatomy)|nail]], intergluteal, and perianal regions.<ref name="pmid19177544">{{cite journal |vauthors=Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM |title=Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study |journal=Arthritis Rheum. |volume=61 |issue=2 |pages=233–9 |date=February 2009 |pmid=19177544 |pmc=3061343 |doi=10.1002/art.24172 |url=}}</ref><ref name="pmid10941813">{{cite journal |vauthors=Elkayam O, Ophir J, Yaron M, Caspi D |title=Psoriatic arthritis: interrelationships between skin and joint manifestations related to onset, course and distribution |journal=Clin. Rheumatol. |volume=19 |issue=4 |pages=301–5 |date=2000 |pmid=10941813 |doi= |url=}}</ref><ref name="pmid87081">{{cite journal |vauthors=Wright V, Roberts MC, Hill AG |title=Dermatological manifestations in psoriatic arthritis: a follow-up study |journal=Acta Derm. Venereol. |volume=59 |issue=3 |pages=235–40 |date=1979 |pmid=87081 |doi= |url=}}</ref>
[[Skin]]:<ref name="pmid10941813" /><ref name="pmid87081" />
*** Scaly, erythematous [[Papule|papules]] and [[Plaque|plaques]]
* Psoriatic arthritis may occur after the onset of [[psoriasis]] in most of the [[Patient|patients]]. However, in some cases, [[arthritis]] precede [[psoriasis]]. The phenotypes of skin [[psoriasis]] that are  associated with an increased risk of psoriatic arthritis are the lesions in the [[scalp]], [[Nail (anatomy)|nail]], intergluteal, and perianal regions.<ref name="pmid19177544" />
*** Pustular lesions
** Scaly, erythematous [[Papule|papules]] and [[Plaque|plaques]]
*** Guttate lesions
** Pustular lesions
*** Auspitz sign: Small [[bleeding]] points seen upon disruption of a psoriatic scale.
** Guttate lesions
** Auspitz sign: Small [[bleeding]] points seen upon disruption of a psoriatic scale.
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* '''Involvement of [[Eye|eyes]]''':<ref name="pmid970993" /><ref name="pmid27419848" />
* Eye involvement:<ref name="pmid970993">{{cite journal |vauthors=Lambert JR, Wright V |title=Eye inflammation in psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=35 |issue=4 |pages=354–6 |date=August 1976 |pmid=970993 |pmc=1007395 |doi= |url=}}</ref><ref name="pmid27419848">{{cite journal |vauthors=Abbouda A, Abicca I, Fabiani C, Scappatura N, Peña-García P, Scrivo R, Priori R, Paroli MP |title=Psoriasis and Psoriatic Arthritis-Related Uveitis: Different Ophthalmological Manifestations and Ocular Inflammation Features |journal=Semin Ophthalmol |volume=32 |issue=6 |pages=715–720 |date=2017 |pmid=27419848 |doi=10.3109/08820538.2016.1170161 |url=}}</ref>  
** [[conjunctivitis]]
** [[conjunctivitis]]
** [[Uveitis]]
** [[Uveitis]]
** [[Iritis]]
** [[Iritis]]
===Neck===
=== Joint Examination===
* Neck examination of patients with [disease name] is usually normal.
* [[Joint]] involvement:<ref name="pmid4581554">{{cite journal |vauthors=Moll JM, Wright V |title=Psoriatic arthritis |journal=Semin. Arthritis Rheum. |volume=3 |issue=1 |pages=55–78 |date=1973 |pmid=4581554 |doi= |url=}}</ref><ref name="pmid17828344">{{cite journal |vauthors=Scarpa R, Peluso R, Atteno M |title=Clinical presentation of psoriatic arthritis |journal=Reumatismo |volume=59 Suppl 1 |issue= |pages=49–51 |date=2007 |pmid=17828344 |doi= |url=}}</ref>
OR
** [[Joint]] [[tenderness]]
*[[Jugular venous distension]]
** [[Joint]] [[Edema|swelling]] may or may not be present
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
** [[Erythema|Redness]] and [[Calor|warmth]]
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
** Patterns of [[joint]] involvement in [[Psoriatic arthritis (patient information)|psoriatic arthritis]] may include according to moll and wright :
*[[Thyromegaly]] / thyroid nodules
*** Distal [[arthritis]]: Involving mostly [[Interphalangeal joint|DIP joints]], may be symmetric or asymmetric. It may involve multiple [[Joint|joints]] or only few [[Joint|joints]].
*[[Hepatojugular reflux]]
*** Asymmetric [[oligoarthritis]]: Most common pattern can be seen in [[Psoriatic arthritis (patient information)|psoriatic arthritis]]. It is characterized by asymmetric involvement of less than 5 small or large [[Joint|joints]].  
*** Symmetric [[polyarthritis]]
*** Arthritis mutilans: Resorption of [[Phalanx bones|phalanges]], [[Metatarsus|metatarsals]] and, [[Metacarpus|metacarpals]].
*** [[Spondylitis]]
*** [[Sacroiliitis]]
[[File:Psoriatic arthritis of feet.jpg|centre|thumb|Joint deformity and nail changes in psoriatic arthritis|Image by - By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9445021]]
** Joint effusion
* [[Achilles tendinitis]]<ref name="pmid12894068">{{cite journal |vauthors=De Simone C, Guerriero C, Giampetruzzi AR, Costantini M, Di Gregorio F, Amerio P, Giampietruzzi AR |title=Achilles tendinitis in psoriasis: clinical and sonographic findings |journal=J. Am. Acad. Dermatol. |volume=49 |issue=2 |pages=217–22 |date=August 2003 |pmid=12894068 |doi= |url=}}</ref>
* [[Dactylitis]]: sausage digit due to swelling of the whole finger or toe.<ref name="pmid15271771">{{cite journal |vauthors=Brockbank JE, Stein M, Schentag CT, Gladman DD |title=Dactylitis in psoriatic arthritis: a marker for disease severity? |journal=Ann. Rheum. Dis. |volume=64 |issue=2 |pages=188–90 |date=February 2005 |pmid=15271771 |pmc=1755375 |doi=10.1136/ard.2003.018184 |url=}}</ref>
* [[Skin]]:<ref name="pmid10941813">{{cite journal |vauthors=Elkayam O, Ophir J, Yaron M, Caspi D |title=Psoriatic arthritis: interrelationships between skin and joint manifestations related to onset, course and distribution |journal=Clin. Rheumatol. |volume=19 |issue=4 |pages=301–5 |date=2000 |pmid=10941813 |doi= |url=}}</ref><ref name="pmid87081">{{cite journal |vauthors=Wright V, Roberts MC, Hill AG |title=Dermatological manifestations in psoriatic arthritis: a follow-up study |journal=Acta Derm. Venereol. |volume=59 |issue=3 |pages=235–40 |date=1979 |pmid=87081 |doi= |url=}}</ref>


===Lungs===
===Extremities===
* Pulmonary examination of patients with [disease name] is usually normal.
* Nail changes:<ref name="pmid28769136">{{cite journal |vauthors=Sobolewski P, Walecka I, Dopytalska K |title=Nail involvement in psoriatic arthritis |journal=Reumatologia |volume=55 |issue=3 |pages=131–135 |date=2017 |pmid=28769136 |pmc=5534507 |doi=10.5114/reum.2017.68912 |url=}}</ref><ref name="pmid27251673">{{cite journal |vauthors=Lai TL, Pang HT, Cheuk YY, Yip ML |title=Psoriatic nail involvement and its relationship with distal interphalangeal joint disease |journal=Clin. Rheumatol. |volume=35 |issue=8 |pages=2031–2037 |date=August 2016 |pmid=27251673 |doi=10.1007/s10067-016-3319-5 |url=}}</ref>
OR
** [[Pitted nails|Nail pits]]
* Asymmetric chest expansion / Decreased chest expansion
** [[Onycholysis]]
*Lungs are hypo/hyperresonant
** [[hyperkeratosis|Subungual hyperkeratosis]]
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
** [[Splinter hemorrhage|Splinter hemorrhages]]
*Rhonchi
** Beau lines
*Vesicular breath sounds / Distant breath sounds
** [[Leukonychia]]
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
** Oil drop patches
*[[Wheezing]] may be present
** Nail crumbling
*[[Egophony]] present/absent
** Nail destruction
*[[Bronchophony]] present/absent
* [[Edema]] of [[Hand|hands]] or feet: Swelling of hands and feet which is asymmetrical with pitting edema may be found in some cases.<ref name="pmid11407082">{{cite journal |vauthors=Cantini F, Salvarani C, Olivieri I, Macchioni L, Niccoli L, Padula A, Falcone C, Boiardi L, Bozza A, Barozzi L, Pavlica P |title=Distal extremity swelling with pitting edema in psoriatic arthritis: a case-control study |journal=Clin. Exp. Rheumatol. |volume=19 |issue=3 |pages=291–6 |date=2001 |pmid=11407082 |doi= |url=}}</ref>
*Normal/reduced [[tactile fremitus]]


===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.


OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
__NOTOC__
{{Psoriatic arthritis}}
{{CMG}}; {{AE}} {{CK}}


==Overview==
==Overview==

Revision as of 19:50, 14 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

  • Physical examination of patients with [disease name] is usually normal.

OR

  • Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
  • The presence of [finding(s)] on physical examination is diagnostic of [disease name].
  • The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

  • Patients with psoriatic arthritis usually appear normal.

Vital Signs

  • Vital signs of patients with psoriatic arthritis are usually within normal limits.

Skin

  • Psoriatic arthritis may occur after the onset of psoriasis in most of the patients. However, in some cases, arthritis precede psoriasis. The phenotypes of skin psoriasis that are associated with an increased risk of psoriatic arthritis are the lesions in the scalp, nail, intergluteal, and perianal regions.[1][2][3]
      • Scaly, erythematous papules and plaques
      • Pustular lesions
      • Guttate lesions
      • Auspitz sign: Small bleeding points seen upon disruption of a psoriatic scale.

HEENT

Joint Examination

Image by - By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9445021

Extremities



Overview

Appearance of the Patient

  • Patients with psoriatic arthritis usually appear normal.

Vital signs

Image by - By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9445021


References

  1. ↑ 1.0 1.1 Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM (February 2009). "Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study". Arthritis Rheum. 61 (2): 233–9. doi:10.1002/art.24172. PMC 3061343. PMID 19177544.
  2. ↑ 2.0 2.1 2.2 Elkayam O, Ophir J, Yaron M, Caspi D (2000). "Psoriatic arthritis: interrelationships between skin and joint manifestations related to onset, course and distribution". Clin. Rheumatol. 19 (4): 301–5. PMID 10941813.
  3. ↑ 3.0 3.1 3.2 Wright V, Roberts MC, Hill AG (1979). "Dermatological manifestations in psoriatic arthritis: a follow-up study". Acta Derm. Venereol. 59 (3): 235–40. PMID 87081.
  4. ↑ 4.0 4.1 Lambert JR, Wright V (August 1976). "Eye inflammation in psoriatic arthritis". Ann. Rheum. Dis. 35 (4): 354–6. PMC 1007395. PMID 970993.
  5. ↑ 5.0 5.1 Abbouda A, Abicca I, Fabiani C, Scappatura N, Peña-García P, Scrivo R, Priori R, Paroli MP (2017). "Psoriasis and Psoriatic Arthritis-Related Uveitis: Different Ophthalmological Manifestations and Ocular Inflammation Features". Semin Ophthalmol. 32 (6): 715–720. doi:10.3109/08820538.2016.1170161. PMID 27419848.
  6. ↑ 6.0 6.1 Moll JM, Wright V (1973). "Psoriatic arthritis". Semin. Arthritis Rheum. 3 (1): 55–78. PMID 4581554.
  7. ↑ 7.0 7.1 Scarpa R, Peluso R, Atteno M (2007). "Clinical presentation of psoriatic arthritis". Reumatismo. 59 Suppl 1: 49–51. PMID 17828344.
  8. ↑ 8.0 8.1 De Simone C, Guerriero C, Giampetruzzi AR, Costantini M, Di Gregorio F, Amerio P, Giampietruzzi AR (August 2003). "Achilles tendinitis in psoriasis: clinical and sonographic findings". J. Am. Acad. Dermatol. 49 (2): 217–22. PMID 12894068.
  9. ↑ 9.0 9.1 Brockbank JE, Stein M, Schentag CT, Gladman DD (February 2005). "Dactylitis in psoriatic arthritis: a marker for disease severity?". Ann. Rheum. Dis. 64 (2): 188–90. doi:10.1136/ard.2003.018184. PMC 1755375. PMID 15271771.
  10. ↑ 10.0 10.1 Sobolewski P, Walecka I, Dopytalska K (2017). "Nail involvement in psoriatic arthritis". Reumatologia. 55 (3): 131–135. doi:10.5114/reum.2017.68912. PMC 5534507. PMID 28769136.
  11. ↑ 11.0 11.1 Lai TL, Pang HT, Cheuk YY, Yip ML (August 2016). "Psoriatic nail involvement and its relationship with distal interphalangeal joint disease". Clin. Rheumatol. 35 (8): 2031–2037. doi:10.1007/s10067-016-3319-5. PMID 27251673.
  12. ↑ 12.0 12.1 Cantini F, Salvarani C, Olivieri I, Macchioni L, Niccoli L, Padula A, Falcone C, Boiardi L, Bozza A, Barozzi L, Pavlica P (2001). "Distal extremity swelling with pitting edema in psoriatic arthritis: a case-control study". Clin. Exp. Rheumatol. 19 (3): 291–6. PMID 11407082.

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