Psoriatic arthritis: when psoriasis attacks joints
An often delayed diagnosis
Dr. Marc Lefèvre
Rheumatologist
An inflammatory spondyloarthritis
Psoriatic arthritis affects 20-30% of psoriasis patients. Joint involvement may precede or follow skin lesions.
Clinical forms
Asymmetric oligoarthritis, distal interphalangeal involvement, mutilating form, axial form (spondylitis), enthesitis, dactylitis ("sausage finger"). Nail involvement (pitting, onycholysis) is a clue.
Diagnosis
Personal/family history of psoriasis, joint ultrasound, MRI. CASPAR criteria.
Treatments
- NSAIDs: mild forms
- Methotrexate, leflunomide: peripheral forms
- Anti-TNF: very effective on skin and joints
- Anti-IL-17 (secukinumab, ixekizumab), anti-IL-23 (guselkumab, risankizumab)
- JAK inhibitors (upadacitinib, tofacitinib)
Overall approach
Weight loss if overweight, smoking cessation, treatment of associated comorbidities (cardiovascular, metabolic).
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