Juvenile nasopharyngeal angiofibroma| aetiology, diagnosis, treatment

Here, we are going to discuss Psoriatic arthropathy (arthritis ) regarding its definition,clinical subtypes, clinical picture (symptoms and signs), diagnostic investigations and treatment approaches .
Definition
• It is an inflammatory arthritis that occurs in about 10 % of patients with psoriasis.
• It shares symptoms, signs and x-ray finding of spondyloarthritis.

How to diagnose Psoriatic arthropathy ?

Clinical picture  There are 5 clinical subtypes
1-Asymmetric oligoarthropathy:-

• There is asymmetric involvemment of both large and small joints
• There is a sausage finger or toe (dactylitis) due to interphalangeal joint synovitis, tensosynovitis and inflammation of the intervening tissues.
2- Symmetric polyarthropathy like rheumatoid disease.
3- Arthritis mutilans:-
• This is a severe destructive arthropathy of fingers and toes with periarticular osteolysis and bone shortening causing telescoping of digits i.e the encasing skin appears invaginated and telescoped.
4- Psoriatic spondylitis with sacroiliitis.

5- Psoriatic nail disease with distal interphalangeal joint involvement.
Investigations

• Rheumatoid factor is negative.

• Anaemia

• Hyperuricemia.

• Polyclonal hypergamma globulinemia.

• There is osteolysis of the metatarsal heads and central erosion of the proximal phalanges causing (pencil cup) appearance.

• Bone resorption giving opera-glass appearance. Also sacroiliitis and spondylitis may present.

Treatment of Psoriatic arthropathy 

• Rest, NSAIDs, local synovitis responds to intraarticular steroid injection.

• Gold and methotrexate are tried.

• Photochemotherapy and long wave U.V light for skin lesions.

• TNF blockers can be used in resistant cases.

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