PSORIATIC SPONDYLOARTHRITIS
 
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PSORIATIC SPONDYLOARTHRITIS

 

DEFINITION:

A seronegative spondyloarthropathy involving entheses with joint and systemic (Ophthalmologic, Skin) manifestations.

EPIDEMIOLOGY:

  • prevalence: 10-15/100,000
  • age of onset:
    • mean: 9-11 years
  • risk factors:
    • HLA-B27
    • F > M (1.2:1)
    • PSORIATIC SPONDYLOARTHRITIS
    • other spondyloarthropathies
      • 5-10% of psoriatics will get Psoriatic Spondyloarthritis
      • family history of 1st degree relative with PSORIATIC SPONDYLOARTHRITIS
  • target joints:
    • major: peripheral - large lower and small upper extremities
    • minor: axial - sacroiliitis, spondylitis

PATHOGENESIS:

1. Background

  • in children, 48% of the time the oligoarthritis precedes the PSORIATIC SPONDYLOARTHRITIS
  • in 40% of cases, the PSORIATIC SPONDYLOARTHRITIS precedes the arthritis and in 12% of cases the arthritis and PSORIATIC SPONDYLOARTHRITIS appear together
  • there appears to be no correlation between the severity of the PSORIATIC SPONDYLOARTHRITIS and the arthritis
  • apparently, there are 5 classifications of arthritis in this disease

CLINICAL FEATURES:

1. Arthritis

1. Axial Joints

1. Sacroilitis

  • axial skeletal disease follows peripheral joint disease by months to years

2. Spondylitis

  • with bony resorption

2. Peripheral Joints

  • scattered oligoarthritis of large (knee, ankle, wrist) and small (PIP, DIP) joints

2. Entheses

  • Enthesitis

3. Systemic Manifestations

1. Ophthalmologic

  • iritis

2. Cutaneous

  • PSORIATIC SPONDYLOARTHRITIS
  • others
    • dactylitis, erythema, tenosynovitis

INVESTIGATIONS:

1. Serum

  • seronegative - RF and ANA
  • HLA-B27 positive

2. Imaging Studies

1. Skeletal X-Rays

  • spine, SI joints
  • peripheral joints
  • entheses

MANAGEMENT:

1. Supportive

  • team approach with long-term follow-up
    • Paediatrics, Dermatology, Ophthalmology, Rheumatology, PT
  • treat PSORIATIC SPONDYLOARTHRITIS
  • physiotherapy to increase range of motion of the peripheral and axial joints
  • enthesitis
    • custom-made insoles
    • ultrasound or transcutaneous nerve stimulation

2. Medications

  • anti-inflammatory drugs
    • ASA
    • NSAID

 

 

 

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