PHAR3912 - Psoriasis & Psoriatic Arthritis

define psoriasis

chronic inflammation hyperplastic skin condition

what are the different types of psoriasis?

plaque: silvery scales, typically symmetrical

nail: increases risk of PsA

flexural

guttate

pustular

erythrodermic

infantile

what are the triggers and risk factors of psoriasis?

genetics

infection

stress

pregnancy

lifestyle

medication (lithium chloroquine, corticosteroid cessation)

what is the PASI score?

assess severity 0-72

>15 = plaque psoriasis

what is the role, MOA, side effects, and limitations of methotrexate?

MOA: immunosuppressant

side effects: cumulative toxicity

limitations: weekly dose

what is the Tx approach to psoriasis in primary care?

topical corticosteroids: anti-inflammatory

tars: anti-inflammatory and antipruritic

calcipotriol: reduce scales

what is the role, MOA, side effects, and limitations of ciclosporin?

MOA: immunosuppressant

side effects: after 2y use

limitations: condition recurs when ceased

what is the role, MOA, side effects, and limitations of phototherapy?

MOA; UVB light -> inhibit inflammatory pathways

side effects: redness, hyperpigmentation

limitations: multiple times a week

what is the role, MOA, side effects, and limitations of acitretin?

MOA: reversal of epidermal proliferation

side effects; skin, eye disorders, pregnancy defects, visual changes

limitations: may cause flares upon initiation

what are the immunological targets of DMARDs and bDMARDs?

cytokines and interleukins

define psoriatic arthritis

chronic inflammatory joint disease (seronegative)

What are the common presentations of psoriatic arthritis?

asymmetric oligoarthritic

dactylitis

enthesitis

What are the FIVE different patterns of joint involvement in psoriatic arthritis?

1. asymmetric oligoarthritic

2. symmetric polyarthritis

3. DIP joints

4. arthritis mutilans

5. spondylarthritis

what is the Tx approach to treatment of mono/ oligoarticular disease?

NSAIDs

intra-articular corticosteroid

DMARDs (if resistant or progressive)

what is the Tx approach to treatment of polyarticular disease?

DMARDs (c/b/t)

why are oral corticosteroids not appropriate for psoriatic arthritis?

can cause flare ups upon dose reductions