Psoriatic arthritis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
Common physical examination findings of patients with psoriatic arthritis include peripheral and axial joint inflammation and tenderness, enthesis, dactylitis, scaly, erythematous papules and plaques on the skin and dystrophic nail changes.
Physical Examination
Appearance of the Patient
- Patients with psoriatic arthritis usually appear normal.
Vital Signs
- Vital signs of patients with psoriatic arthritis are usually within normal limits.
Skin
- Psoriatic arthritis may occur after the onset of psoriasis in most of the patients. However, in some cases, arthritis precede psoriasis. The phenotypes of skin psoriasis that are associated with an increased risk of psoriatic arthritis are the lesions in the scalp, nail, intergluteal, and perianal regions.[1][2][3]
HEENT
Joint Examination
- Joint involvement:[6][7]
- Joint tenderness
- Joint swelling may or may not be present
- Redness and warmth
- Patterns of joint involvement in psoriatic arthritis may include according to moll and wright :
- Distal arthritis: Involving mostly DIP joints, may be symmetric or asymmetric. It may involve multiple joints or only few joints.
- Asymmetric oligoarthritis: Most common pattern can be seen in psoriatic arthritis. It is characterized by asymmetric involvement of less than 5 small or large joints.
- Symmetric polyarthritis
- Arthritis mutilans: Resorption of phalanges, metatarsals and, metacarpals.
- Spondylitis
- Sacroiliitis
- Joint effusion
- Achilles tendinitis[8]
- Dactylitis: sausage digit due to swelling of the whole finger or toe.[9]
Extremities
- Nail changes:[10][11]
- Nail pits
- Onycholysis
- Subungual hyperkeratosis
- Splinter hemorrhages
- Beau lines
- Leukonychia
- Oil drop patches
- Nail crumbling
- Nail destruction
- Edema of hands or feet: Swelling of hands and feet which is asymmetrical with pitting edema may be found in some cases.[12]
Cardiovascular Examination
- Patients with psoriatic arthritis present with following cardiovascular manifestations.[13]
- Increased risk for atherosclerosis and myocardial infarction
- Congestive heart failure
- Peripheral vascular disease
- Arrhythmia
Lungs
- Pneumonitis[14]
- Pulmonary fibrosis
References
- ↑ Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM (February 2009). "Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study". Arthritis Rheum. 61 (2): 233–9. doi:10.1002/art.24172. PMC 3061343. PMID 19177544.
- ↑ Elkayam O, Ophir J, Yaron M, Caspi D (2000). "Psoriatic arthritis: interrelationships between skin and joint manifestations related to onset, course and distribution". Clin. Rheumatol. 19 (4): 301–5. PMID 10941813.
- ↑ Wright V, Roberts MC, Hill AG (1979). "Dermatological manifestations in psoriatic arthritis: a follow-up study". Acta Derm. Venereol. 59 (3): 235–40. PMID 87081.
- ↑ Lambert JR, Wright V (August 1976). "Eye inflammation in psoriatic arthritis". Ann. Rheum. Dis. 35 (4): 354–6. PMC 1007395. PMID 970993.
- ↑ Abbouda A, Abicca I, Fabiani C, Scappatura N, Peña-García P, Scrivo R, Priori R, Paroli MP (2017). "Psoriasis and Psoriatic Arthritis-Related Uveitis: Different Ophthalmological Manifestations and Ocular Inflammation Features". Semin Ophthalmol. 32 (6): 715–720. doi:10.3109/08820538.2016.1170161. PMID 27419848.
- ↑ Moll JM, Wright V (1973). "Psoriatic arthritis". Semin. Arthritis Rheum. 3 (1): 55–78. PMID 4581554.
- ↑ Scarpa R, Peluso R, Atteno M (2007). "Clinical presentation of psoriatic arthritis". Reumatismo. 59 Suppl 1: 49–51. PMID 17828344.
- ↑ De Simone C, Guerriero C, Giampetruzzi AR, Costantini M, Di Gregorio F, Amerio P, Giampietruzzi AR (August 2003). "Achilles tendinitis in psoriasis: clinical and sonographic findings". J. Am. Acad. Dermatol. 49 (2): 217–22. PMID 12894068.
- ↑ Brockbank JE, Stein M, Schentag CT, Gladman DD (February 2005). "Dactylitis in psoriatic arthritis: a marker for disease severity?". Ann. Rheum. Dis. 64 (2): 188–90. doi:10.1136/ard.2003.018184. PMC 1755375. PMID 15271771.
- ↑ Sobolewski P, Walecka I, Dopytalska K (2017). "Nail involvement in psoriatic arthritis". Reumatologia. 55 (3): 131–135. doi:10.5114/reum.2017.68912. PMC 5534507. PMID 28769136.
- ↑ Lai TL, Pang HT, Cheuk YY, Yip ML (August 2016). "Psoriatic nail involvement and its relationship with distal interphalangeal joint disease". Clin. Rheumatol. 35 (8): 2031–2037. doi:10.1007/s10067-016-3319-5. PMID 27251673.
- ↑ Cantini F, Salvarani C, Olivieri I, Macchioni L, Niccoli L, Padula A, Falcone C, Boiardi L, Bozza A, Barozzi L, Pavlica P (2001). "Distal extremity swelling with pitting edema in psoriatic arthritis: a case-control study". Clin. Exp. Rheumatol. 19 (3): 291–6. PMID 11407082.
- ↑ Han C, Robinson DW, Hackett MV, Paramore LC, Fraeman KH, Bala MV (November 2006). "Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis". J. Rheumatol. 33 (11): 2167–72. PMID 16981296.
- ↑ Salaffi F, Manganelli P, Carotti M, Subiaco S, Lamanna G, Cervini C (May 1997). "Methotrexate-induced pneumonitis in patients with rheumatoid arthritis and psoriatic arthritis: report of five cases and review of the literature". Clin. Rheumatol. 16 (3): 296–304. PMID 9184269.