Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis
Mar 26, 2015
Pathophysiology
PsoriasisPsoriatic Arthritis
Cellulitis
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nerps
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PSORIATIC ARTHRITIS
An inflammatory arthritis that occurs in a patient with psoriasis.
Harrison’s Internal Medicine 17th edition
A form of arthritis that occurs in patients with psoriasis with the hallmarks of an "inflammatory" arthritis, including joint pain, erythema, and swelling, often
with prominent stiffness. Mease, P., Menter, A. (2005) , Psoriatic Arthritis: Understanding Its Pathophysiology and Improving Its
Diagnosis and Management. Retrieved from: http://cme.medscape.com/viewarticle/509053
Clinical Features
• Unique to Psoriatic Arthritis:– DIP joint involvement– Nail changes – Dactylitis – Enthesitis– Spondylitis Lytic and periarticular new bone
formation x-ray features – Iritis or Uveatis
Mease, P., Menter, A. (2005) , Psoriatic Arthritis: Understanding Its Pathophysiology and Improving Its Diagnosis and Management. Retrieved from: http://cme.medscape.com/viewarticle/509053
Clinical Features
• Patterns of Arthropathy1. Arthritis of DIP joints2. Asymmetric oligoarthritis3. Symmetric polyarthritis4. Axial involvement5. Arthritis Mutilans
Psoriatic Arthritis
Distal Interphalangeal joint arthritis
• Occurs in 15 % of cases• Nail changes also seen
Harrison’s Internal Medicine 17th edition
Psoriatic Arthritis
• Asymmetric Oligoarthritis• Involves the knee or any large joint
with a few small joints in the fingers and toes– Metarsophalangeal– Proximal interphalengeal– Distal interphalengeal
• Dactylis– Sausage shaped digits due to inflammation of
the flexor tendons and synovium and pitting edema of the distal extremities may be observed
Harrison’s Internal Medicine 17th edition
Psoriatic Arthritis
Symmetric polyarthritis• Affects the Hands, wrists, knees,
and feet symmetrically– Proximal interphalangeal joints– Metacarpophalangeal joints
• Peripheral joints are less tender compared to RA
Harrison’s Internal Medicine 17th edition
Psoriatic Arthritis
Axial Arthropathy • Spine and sacroiliac
joints
Harrison’s Internal Medicine 17th edition
Psoriatic Arthritis
Arthritis mutilans• Widespread shortening or
telescoping of digits due to osteolysis of the phalanges and metacarpals
• coexisting with ankylosis and contractures in other digits
• opera-glass deformity or pencil-in-cup radiographic findings
• Fever
Harrison’s Internal Medicine 17th edition
Nail Changes
• Pitting• Horizontal ridging• Onycholysis• Discoloration of nail
margins• Dystrophic
hyperkeratosisOnycholysis
Nail pitting
OnychodystrophyHarrison’s Internal Medicine 17th edition
Dactylitis
Involvement of the distal and proximal interphalangeal joints, together with tendon
sheath involvement, may give the digit a sausage shape
Harrison’s Internal Medicine 17th edition
Enthesitis
Inflammation at the sites of ligamentous and tendinous insertions
Emedicine Retrieved from: http://emedicine.medscape.com/article/1108557-overview
Risk Factors:•Immunocompromised due to meds•Auspitz sign – break in skin integrity
Psoriasis
Cellulitis
Indigenous flora colonizing the skin
Staphylococcus aureusStreptococcus
pyogenesExogenous bacteria
Indigenous flora colonizing the skin
Staphylococcus aureusStreptococcus
pyogenesExogenous bacteria
Harrison’s Principles of Internal Medicine 17th ed.
Cellulitis• At the involved site
– Localized pain– Erythema – Swelling– Warmth– Borders are not sharply
demarcated
• Fever and chills• Malaise
Harrison’s Principles of Internal Medicine 17th ed.