Home | | Medicine and surgery: Principles and practice of medicine and surgery | Psoriatic arthritis - Seronegative arthritides (spondyloarthropathies)

Chapter: Medicine and surgery: Musculoskeletal system

Psoriatic arthritis - Seronegative arthritides (spondyloarthropathies)

A chronic inflammatory arthritis occurring with psoriasis. - Definition, Incidence, Age, Sex, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Psoriatic arthritis




A chronic inflammatory arthritis occurring with psoriasis.




1% of population have psoriasis of which 5% will get arthritis.


Peak incidence age: 30–50 years.








Genetic factors: Psoriasis and psoriatic arthritis have a familial tendency particularly in first-degree relatives. There are some twin studies suggesting increased monozygotic concordance. A number of HLA anti-gens are related to the development of psoriasis and psoriatic arthritis especially B27, and there are genetic linkage studies to a number of loci.


Environmental factors include bacterial and viral infections and trauma. Trauma may be implicated as psoriatic skin lesions exhibit the Koebner phenomenon (lesion develop at sites of trauma).



Synovitis is histologically the same as that of rheumatoid arthritis, although bone resorption is sometimes prominent. It is likely that both the skin lesions and the arthritis are immunologically mediated.


Clinical features


There are usually psoriatic lesions of the skin but the severity is unrelated to the development of arthritis. Psoriatic nail involvement is related to an increased risk of psoriatic arthritis. Five patterns of arthritis are seen:


i.      Distal interphalangeal joint synovitis, which is often asymmetrical.


ii.      Asymmetric oligo/monoarthritis.


iii.      Symmetrical rheumatoidlike polyarthritis.


iv.      Arthritis mutilans is a rare deforming – destructive arthritis with marked bone resorption.


v.      Spondyloarthropathy similar to ankylosing spondylitis affects the spine and sacroiliac joints.




Blood tests may show raised inflammatory markers, anaemia of chronic disease and presence of autoantibodies (ANA and RhF).


X-ray: There is a combination of erosions and new bone formation in distal joints. Other features include periostitis, bone resorption, sacroiliitis and spondylitis.



Pain and inflammation is treated with nonsteroidal anti-inflammatory drugs. Specific Cox II inhibitors may be of value (see indications given in section on Rheumatoid Arthritis). Second line agents include methotrexate and ciclosporin. Anti-TNF-α monoclonal antibodies have been shown to be effective in reducing the progression of psoriatic arthritis. Surgical intervention may prove necessary.




It is not clear whether any medical intervention has disease-modifying potential.

Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail
Medicine and surgery: Musculoskeletal system : Psoriatic arthritis - Seronegative arthritides (spondyloarthropathies) |

Related Topics

Medicine and surgery: Musculoskeletal system

Privacy Policy, Terms and Conditions, DMCA Policy and Compliant

Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.