Seronegative spondyloarthropathies - psoriatic arthritis
Description
- Inflammatory arthritis with psoriasis, RF-negative, part of the spondyloarthritis family
- Multi-domain disease - each domain responds to different drugs, so the domains must be counted individually
Six domains
- Peripheral arthritis
- Axial disease
- Enthesitis
- Dactylitis
- Skin psoriasis
- Nail disease
Moll and Wright patterns (may change over time in the same patient)
- Asymmetric oligo/monoarthritis (<5 joints) - historically the commonest at presentation
- Symmetric polyarthritis - RA-like
- Axial (AS-like) - often asymmetric sacroiliitis, less severe than AS
- DIP-predominant with nail disease
- Arthritis mutilans - severe osteolysis, telescoping digits (<5%)
The pattern discriminators from RA
- "Ray" not "row": all joints of one digit (ray/axial), not the same joint across digits (row)
- DIP involvement
- Dactylitis ("sausage digit") - whole-digit swelling from tenosynovitis + synovitis
- Enthesitis - Achilles, plantar fascia
- Asymmetry
- Nail disease
6 more sections, plus exam facts
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