Psoriatic Arthritis

167 Pages·2009·0.9 MB·English

by  Dafna D. Gladman

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Psoriatic
arthritis
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Psoriatic
arthritis
Dafna D. Gladman
MD, FRCPC
Professor of Medicine, University of Toronto;
Senior Scientist, Toronto Western Research Institute;
University Health Network, Toronto Western Hospital,
Toronto, Ontario, Canada
Vinod Chandran
MBBS, MD, DM
Clinical Research Fellow, University of Toronto;
Centre for Prognosis Studies in the Rheumatic Diseases;
University Health Network, Toronto Western Hospital,
Toronto, Ontario, Canada
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Contents
1 What is psoriatic arthritis? 1
2 The relationship between psoriasis and
psoriatic arthritis 11
3 Psoriatic arthritis and other spondyloarthritides 19
4 What causes psoriatic arthritis 25
5 Clinical features of psoriatic arthritis 33
6 Radiological features of psoriatic arthritis 47
7 How is the diagnosis of psoriatic arthritis made? 57
8 Functional and emotional impact 65
9 Non-drug therapy 71
10 Drug therapy 77
11 Surgery in psoriatic arthritis 89
12 A team approach 97
13 Lessons from the University of Toronto
Psoriatic Arthritis Clinic 103
14 International collaborations 121
15 Current outlook for patients with
psoriatic arthritis 129
List of professional and patient
advocacy organizations 133
Glossary 145
Index 151
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What is psoriatic
arthritis?
06
Key points
◆ Psoriasis is a chronic infl ammatory skin condition
◆ Psoriatic arthritis is an infl ammatory arthritis occurring in patients
with psoriasis
◆ Psoriatic arthritis affects 10–30% of patients with psoriasis
◆ Psoriatic arthritis affects the peripheral and spinal joints
◆ CASPAR criteria facilitate the diagnosis
Psoriasis is a chronic infl ammatory skin condition which presents most com-
monly with red plaques over the extensor surfaces of the elbows and knees, as
well as in the scalp (Fig. 1.1, p. 2). Specifi c nail lesions are also common in
patients with psoriasis (Fig. 1.2).
Historical perspective
The occurrence of a form of arthritis among patients with psoriasis was fi rst
noted in the nineteenth century, although evidence of the disease was noted in
archeological fi ndings from the Judean desert, dating the disease much earlier
than that. Baron Aliberti fi rst described the association between psoriasis and
arthritis (Table 1.1). Later in the nineteenth century several French physicians
recognized the presence of a form of arthritis among patients with psoriasis.
However, over the ensuing years many investigators considered the arthritis
associated with psoriasis to be a variant of rheumatoid arthritis, which
was the main known infl ammatory form of arthritis at the time. Psoriatic
arthritis was fi nally recognized as an entity separate from rheumatoid arthritis
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Psoriatic arthritis · thefacts
Figure 1.1 Lesions typical of chronic plaque psoriasis on the back.
a) Onycholysis
b) Nail pits
Figure 1.2 Typical changes seen on the nails of patients with psoriasis.
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Chapter 1 · What is psoriatic arthritis?
when it was found that the majority of patients with psoriatic arthritis were
negative for a test for rheumatoid factor. Rheumatoid factor is a test discov-
ered in 1948 that is found to be positive in about 85% of patients with rheu-
matoid arthritis but in fewer than 15% of patients with psoriatic arthritis.
Patients who are negative for rheumatoid factor are said to be
‘seronegative’.
0Q
Myth
Psoriatic arthritis is the chance occurrence of infl ammatory arthritis in
patients with psoriasis.
01
Fact
Psoriatic arthritis is a specifi c infl ammatory arthritis that occurs com-
monly in patients with psoriasis.
Thus, it was only in the latter half of the twentieth century, with the
classical descriptions of the varied presentations of psoriatic arthritis by Professor
Verna Wright and Dr John Moll in Leeds, UK, that psoriatic arthritis truly
Table 1.1 History of psoriatic arthritis
1818 Baron Jean Luis Aliberti describes association between psoriasis and arthritis
1860 Pierre Bazin uses term ‘psoriasis arthritique’
1888 Charles Bourdillon writes a doctoral thesis entitled ‘Psoriasis et Arthropathies’
1937 Jeghers and Robinson hold that psoriatic arthritis is a unique entity
1939 Bauer writes: ‘there is little justifi cation for considering these patients as suffering
from a distinct disease entity’
1951 Vilanova and Pinol describe psoriatic arthritis
1956 Wright reports on psoriasis and arthritis
1958 Cost and colleagues report on a large series of psoriatic arthritis patients
1959 Wright compares psoriatic arthritis and rheumatoid arthritis
1964 The American Rheumatism Association (ARA) recognizes psoriatic arthritis as an entity
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