- PsA is a seronegative spondyloarthropathy characterized by inflammatory arthritis and enthesitis.
- 5 patterns of arthritis in PsA include:
- Asymmetric oligoarthritis: Usually involves large joints
- Distal interphalangeal (DIP) joint predominant: Often associated with nail psoriasis
- Symmetric polyarthritis: May be indistinguishable from rheumatoid arthritis (RA)
- Spondyloarthritis: Asymmetric and discontinuous, unlike ankylosing spondylitis (AS)
- Arthritis mutilans: Destructive, resorptive arthritis; produces so-called opera-glass or telescoping digit
- Although psoriasis generally is present, it may be limited in extent:
- Course of arthritis and extent of psoriasis do not appear to correlate.
- Other extra-articular features, such as iritis, are less common.
- Damaging joint disease may occur in 40–57%. Characteristic radiologic changes include joint erosions that begin marginally and move centrally (“pencil-in-cup deformity”) and periostitis.
- Rheumatoid factor (RF) and cyclic citrullinated peptide (anti-CCP) antibody are usually negative. HLA-B27 may be positive.
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