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Most patients with this skin condition develop arthritis
19%
485/2522
All patients that develop arthritis are positive for HLA-B27
7%
183/2522
The skin lesions respond well to systemic anti-fungal therapy
1%
29/2522
Rheumatoid factor and ANA are usually positive
17%
435/2522
DIP erosions are often centripetal
54%
1361/2522
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The clinical presentation is consistent with psoriatic arthritis. DIP joint involvement is characterized by centripetal erosions (pencil-in-cup deformity). Psoriatic arthritis is one of the seronegative spondyloarthropathies. As such, it most commonly will have have a negative rheumatoid factor and a predilection for patients with the HLA-B27 gene. The majority of patients with psoriasis do not develop psoriatic arthritis. For those that do develop arthritis, the hands and feet are often involved with the DIP joints classically affected. The centripetal erosions and classic pencil-in-cup deformity help differentiate it from osteoarthritis. These patients require referral to and management by a rheumatologist, as first-line therapies are medically based. Choo et al. review inflammatory arthroses of the hand and wrist. They state that the management of these and several other conditions is typically medical in nature and continues to evolve with the development of biologically targeted medications. Surgical treatment is infrequently undertaken but can be efficacious for severe cases to alleviate symptoms and for deformity correction. Taylor et al. discuss the development of a new classification system for psoriatic arthritis. The CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria is a scoring system based on some of the most common manifestations. Figures A, B, and C are clinical pictures of a psoriatic plaque, nail pitting, and dactylitis, respectively. These are classic manifestations of psoriatic arthritis. Illustration A shows the classic centripetal erosion in a left hand with psoriatic arthritis. Due to the erosions and osteolysis, the joint space often widens and deformity may develop. Illustration B is the CASPAR criteria for the diagnosis of psoriatic arthritis. Incorrect Answers: Answer 1: Only 5-20% of patients with psoriasis develop psoriatic arthritis. Answer 2: Approximately 50% of patients with psoriatic arthritis are HLA-B27 positive. Answer 3: The skin lesions are not a result of a fungal infection and are therefore not treated with anti-fungal medications. Answer 4: RF and ANA are usually negative in psoriatic arthritis.
1.8
(5)
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