eMedicine Specialties > Rheumatology > Spondyloarthropathies

Psoriatic Arthritis: Follow-up

Author: Anwar Al Hammadi, MD, FRCPC, Consultant Dermatologist, Assistant Clinical Professor of Dermatology, University of Sharjah, Dubai, United Arab Emirates
Contributor Information and Disclosures

Updated: Apr 29, 2009

Follow-up

Further Outpatient Care

  • Heat and cold treatments can temporarily relieve pain and reduce joint swelling. Examples of treatments include soaking in a warm tub or placing a warm compress or cold pack on the painful joint.

Deterrence/Prevention

  • A number of medications cause an exacerbation of psoriasis; therefore, avoidance of these medications may help prevent or minimize flare-ups.
    • Lithium and withdrawal from systemic corticosteroids are well known to cause flares of disease.
    • Beta-blockers, antimalarials, and NSAIDs have also been implicated.

Complications

  • Until recently, psoriatic arthritis was generally believed to be a mild disease, with severe joint deformity and destruction (called arthritis mutilans) occurring in only approximately 5% of patients. This severe condition usually occurs in the small joints of the hands and feet. Some reports now suggest that arthritis mutilans may occur in as many as 16% of patients and that it may be as severe as rheumatoid arthritis (RA).
  • Atlantoaxial subluxation with attendant neurological complications can occur. Rarely, patients with psoriatic arthritis may develop aortic insufficiency.

Prognosis

  • Until recently, psoriatic arthritis generally had been considered a milder disease than RA. The following factors influence the degree of severity:
    • Clinical subset (eg, arthritis mutilans, symmetric polyarthritis)
    • Early age of onset
    • Severity of skin involvement
    • Female sex
    • Family history of arthritis
    • HLA marker: Patients with HLA-B39 and HLA-B27 in the presence of HLA-DR7 are more likely to experience disease progression, while those with HLA-B22 or HLA-DQw3 in the presence of HLA-DR7 may be protected from disease progression.
    • ESR of greater than 15 mm/h, medication use before the first clinical visit, evidence of radiologic damage, and absence of nail lesions: These factors have been associated with increased mortality.
  • New evidence suggests that psoriatic arthritis may be as disabling and destructive as RA when the appropriate comparisons are made; thus, treatment should be aggressive in those individuals with progressive joint disease.

Patient Education

Miscellaneous

Special Concerns

  • Children with juvenile psoriatic arthritis should be examined by an ophthalmologist annually to check for the several forms of eye inflammation usually associated with various forms of juvenile arthritis.
 


More on Psoriatic Arthritis

Overview: Psoriatic Arthritis
Differential Diagnoses & Workup: Psoriatic Arthritis
Treatment & Medication: Psoriatic Arthritis
Follow-up: Psoriatic Arthritis
Multimedia: Psoriatic Arthritis
References
Further Reading
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Further Reading

For additional information, see Medscape’s Psoriasis Resource Center and Arthritis Resource Center.

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Keywords

psoriatic arthritis, spondylitic psoriatic arthritis, rheumatoid psoriatic arthritis, psoriasis, arthritis, skin disease, bone disease, rheumatism, rheumatoid arthritis, psoriatic arthropathy, arthritis mutilans, arthropathia psoriatica, psoriatic spondylitis, asymmetrical seronegative oligoarticular arthritis, dactylitis, sausage digits, pencil-in-cup radiograph, opera-glass hand, asymmetrical oligoarticular arthritis, symmetrical polyarthritis, distal interphalangeal arthropathy, juvenile psoriatic arthritis, sacroiliitis

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Contributor Information and Disclosures

Author

Anwar Al Hammadi, MD, FRCPC, Consultant Dermatologist, Assistant Clinical Professor of Dermatology, University of Sharjah, Dubai, United Arab Emirates
Anwar Al Hammadi, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, Canadian Dermatology Association, Royal College of Physicians and Surgeons of Canada, and Skin Cancer Foundation
Disclosure: Nothing to disclose.

Medical Editor

Kristine M Lohr, MD, MS, Program Director, Professor, Department of Internal Medicine, Division of Rheumatology and Women's Health, University of Kentucky School of Medicine
Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Medical Women's Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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