Psoriatic Arthritis Clinical Manifestations
There are five clinical patterns of psoriatic arthritis, which may evolve from one to another, and are not necessarily mutually exclusive:
- Asymmetrical mono- and oligoarticular arthritis (30-50% of cases) is the most common presentation of psoriatic arthritis.
- Symmetrical polyarticular arthritis (30-50% of cases) is ultimately the most common form of psoriatic arthritis.
- Distal interphalangeal (DIP) joint involvement (25% of cases) is nearly always associated with nail manifestationsm (image below).
- Arthritis mutilans (5% of cases) is characterized by resorption of the phalangeal bones. (image below)
- Axial arthritis (30-35% of cases) may be different in character from ankylosing spondylitis, the prototypical HLA-B27-associated spondyloarthropathy. It may present as sacro-iliitis, which may be asymmetrical and asymptomatic, or spondylitis, which may occur without sacro-iliitis and may affect any level of the spine in "skip" fashion.
In addition to psoriatic plaques themselves, there are a number of other characteristic, though not necessarily pathognomonic, features of psoriatic arthritis:
- Nail involvement may be manifested as pitting, ridging, separation from the nail bed (onycholysis) (image below)
or yellow-orange discoloration ("oil drop" sign). (image below)
- Dactylitis presents as the so-called "sausage digit", diffuse swelling of the entire digit likely due to a combination of both arthritis and tenosynovitis. (image below)
- Enthesitis, inflammation at the site of ligamentous and tendinous insertion (image below), is characteristic of all the HLA-B27-associated spondyloarthropathies.
- Extra-cutaneous and -articular manifestations are uncommon but may include conjunctivitis, uveitis, aortic insufficiency and pulmonary fibrosis.
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*Images within this article are from the American College of Rheumatology Slide Collection.
