OTHER ARTICULAR MANIFESTATIONS IN PSORIATIC ARTHRITIS

Dactylitis

Dactylitis, or sausage digit, is a typical feature of PsA.  It refers to infl ammation of the whole digit. It likely

results from both synovitis in the joints of the digit, as well as tenosynovitis, particularly in the fl exor tendons.

Dactylitis most commonly affects the toes, but fingers are affected as well. 

It should be noted that dactylitis may become chronic, such that it is no longer painful or red, but remains as a chronically swollen digit, which may not respond to therapeutic intervention.

Dactylitis http://www.cdaarthritis.com/images_slides/43_spon2_d_adactylitisfinger_720.jpg

Tenosynovitis

Tendonitis or tenosynovitis occurs frequently among patients with PsA. Infl ammation may affect the fl exortendons of the fingers, as well as the extensor carpi ulnaris, sites that are commonly affected in RA. Achillestendonitis is commonly seen, as is plantar fascitis. These may interfere with function and may lead to disability. In PsA, tendonitis may be associated with tendon nodules and signifi cant functional limitation.

 

Tenosynovitis http://www.riversideonline.com/source/images/image_popup/r7_dequervains.jpg

Enthesitis

Infl ammation of the enthesis, site of insertion of tendoninto bone, is another typical feature of PsA. Enthesitis

may occur at any tendon insertion site, but most commonlyaffects the plantar fascia, Achilles tendon insertion,

insertion of tendons at the knee and shoulder, aswell as the pelvic bones. It has been suggested thatenthesitis alone in the presence of psoriasis may be sufficient for the diagnosis of PsA.

                               

Enthesitis  http://www.cdaarthritis.com/images_slides/43_spon2_b_achillesenthesopathy_360.jpg

 

Other Extra-Articular

Manifestations

Iritis is an extra-articular feature common to all spondyloarthropathies and is also seen among patients with

PsA. Some 7% of patients with PsA present with iritis,and it can also be seen among patients with psoriasis

without arthritis.

Urethritis is also a feature of seronegative disease. It

is less common in PsA than in the other members of the

spondyloarthritis group.

Bowel involvement may occur in patients with PsA

and is usually nonspecifi c colitis.

Cardiac abnormalities have been reported among

patients with PsA, including dilatation of the base of

the aortic arch which occurs in ankylosing spondylitis.

More recently it has been recognized that patients

with PsA are at risk for cardiovascular disease.

This may be related to the metabolic abnormalities

associated with PsA, including hyperlipidemia, hyperuricemia,

as well as lifestyle factors such as obesity and

smoking.