Psoriatic Arthropathy
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Keywords:
Dactylitis
Inflammatory arthritis
Spondylitis
Arthropathy
Psoriatic arthritis (PsA), one of the spondyloarthritides (SpA), is an inflammatory musculoskeletal disease associated with psoriasis, classified according to the ClASsification for Psoriatic Arthritis (CASPAR) criteria1. PsA is a heterogeneous disease; manifestations vary within and between patients and commonly involve the skin, joints, and occasionally the eye and gastrointestinal tract2. With the aim to better study the most common manifestations of PsA, clinical trials and treatment recommendations have classified the cutaneous and musculoskeletal manifestations into domains3. These include skin, nails, peripheral arthritis, enthesitis, dactylitis, and axial arthritis3. Experts in PsA have largely reached consensus on the definition and tools for assessment of skin, nails, peripheral arthritis, enthesitis, and dactylitis. Recent clinical trials have provided evidence of varying efficacy of interventions for active disease in these domains4. PsA patients with axial arthritis (axPsA) tend to have more severe disease5. Compared to those without axial disease, these patients have higher likelihood of moderate/severe psoriasis, higher disease activity, and greater effect on quality of life and function5. Therefore, determining whether the axial domain is involved may have prognostic value. However, the axial arthritis domain is the least studied; the tools of assessment and treatment recommendations … Address correspondence to V. Chandran, 1E-416, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario M5T2S8, Canada. E-mail: vinod.chandran{at}uhnresearch.ca.
Dactylitis
Inflammatory arthritis
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Psoriatic arthritis (PsA) is a form of spondyloarthritis, a group of conditions that share a spectrum of components including arthritis, enthesitis, dactylitis, and spine inflammation. In PsA, however, the unpredictable, heterogeneous, and often insidious involvement of joints or juxtaarticular tendons and ligaments can sometimes make clinical recognition of the disease a challenge. Underrecognition of PsA may be due to the absence of a single sensitive and specific diagnostic measure. Although the ClASsification of Psoriatic ARthritis (CASPAR) criteria introduced in 2006 have improved disease classification, they are designed to be applied to cases already diagnosed with inflammatory arthritis. Therefore, in order for these criteria to be applied, the clinician is required to recognize the presence of inflammatory arthritis, enthesitis, or spondylitis. At the 2010 annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis), the need to define inflammatory arthritis, enthesitis, dactylitis, and spondylitis, especially for nonrheumatologists, was discussed. Conclusions from breakout group discussions are summarized.
Dactylitis
Inflammatory arthritis
Spondylitis
Reactive arthritis
Enthesis
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Psoriatic arthritis (PsA) is a chronic inflammatory disease that is remarkably diverse in its presentation and course. Important domains of involvement include peripheral arthritis, skin and nail psoriasis, enthesitis, dactylitis, and axial arthritis, along with associated conditions such as inflammatory bowel disease (IBD) and anterior uveitis.1,2
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Reactive arthritis
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Abstract Spondyloarthritis (SpA) is a group of diseases characterized by back pain, spinal inflammation, human leukocyte antigen-B27 positivity, and peripheral findings such as dactylitis, enthesitis, and uveitis. It includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated SpA. The role of imaging in the diagnosis, management, and follow-up of patients with SpA has become dramatically more important with the introduction of new therapies such as tumor necrosis factor-α inhibitors. Although in many instances differentiating between the SpA entities is straightforward based on the clinical presentation, often such differentiation remains challenging, and categorization of an individual patient into a subset of SpA can be difficult. Imaging, mainly radiography and magnetic resonance imaging, serves as an important diagnostic tool. Diseases in the spondyloarthritis complex share common presentation but at the same time may have distinct radiographic phenotypes. We present these common and distinct imaging manifestations that may potentially help distinguish between the entities in the diagnostic work-up.
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Dermatologist and primary care clinicians are in an ideal position to identify the emergence of psoriatic arthritis (PsA) in patients with psoriasis. Yet these clinicians are not well trained to distinguish inflammatory musculoskeletal disease from other more common problems such as osteoarthritis, traumatic or degenerative tendonitis and back pain, or fibromyalgia. A simple set of clinical criteria to identify inflammatory disease would aid recognition of PsA. At its 2012 annual meeting, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) discussed development of evidence-based, practical, and reliable definitions of inflammatory arthritis, enthesitis, dactylitis, and spondylitis. This project will be a sequential process of expert clinician nominal-group technique, patient surveys and focus groups, and Delphi exercises to identify core features of inflammatory disease, testing these in a small group of patients with and without inflammatory disease, and finally validating these criteria in larger groups of patients.
Dactylitis
Spondylitis
Inflammatory arthritis
Spondyloarthropathy
Tenosynovitis
Delphi Method
Enthesopathy
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Dactylitis
Reactive arthritis
Inflammatory arthritis
Spondylitis
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Citations (5)
Objective. To describe a research project to develop simple clinical criteria to aid in the identification of inflammatory arthritis, enthesitis, dactylitis, and spondylitis and distinguish these from non-inflammatory conditions. The criteria are particularly intended to aid non-rheumatologists, e.g., dermatologists, who need assistance identifying psoriatic arthritis in patients with psoriasis, but may be useful to all clinicians in properly diagnosing rheumatologic conditions. Methods. The proposed research methodology includes the use of a nominal group exercise among expert clinicians and patient focus groups, Delphi exercises among clinicians and patients, application of criteria test sets to a small group of representative patients with inflammatory and non-inflammatory musculoskeletal conditions, and validation by application of optimal criteria sets to large groups of patients with inflammatory and noninflammatory conditions. Results. Examples of elements to describe inflammatory conditions derived from a nominal group exercise conducted at the 2013 GRAPPA annual meeting are described, along with planned project activities. Conclusion. This project will lead to the development of practical criteria to aid in the diagnosis and appropriate clinical care of patients with chronic inflammatory musculoskeletal conditions.
Dactylitis
Inflammatory arthritis
Spondylitis
Delphi Method
Nominal Group Technique
Delphi
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The most widely applied criteria for classifying psoriatic arthritis (PsA) are the CASPAR (ClASsification of Psoriatic ARthritis) criteria. A patient who fulfills the CASPAR criteria must have evidence of inflammatory arthritis, enthesitis, or spondylitis, and may have an inflammatory musculoskeletal component, dactylitis. Although the criteria were developed by rheumatologists, not all patients with PsA are seen by rheumatologists. Thus, it is important for clinicians such as dermatologists, primary care providers, physiatrists, and orthopedists, and patients themselves, to be able to recognize the presence of inflammatory musculoskeletal disease and distinguish it from degenerative or traumatic musculoskeletal disease. At their 2010 annual meeting, members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) discussed the steps they are taking to define the key variables that must be present to distinguish inflammatory arthritis, enthesitis, and dactylitis from degenerative, traumatic, mechanical, or infectious forms of these conditions.
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Inflammatory arthritis
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Rheumatologists are trained to determine the presence of musculoskeletal inflammation through history, physical examination, and if needed, laboratory tests and imaging. However, primary care clinicians, dermatologists, surgeons, and others who may initially see patients with musculoskeletal pain are not necessarily able to make the distinction between inflammatory (e.g., rheumatoid arthritis or psoriatic arthritis) and noninflammatory disease (osteoarthritis, traumatic or degenerative tendonitis, back pain, or fibromyalgia). If such clinicians could more readily suspect and identify possible inflammatory musculoskeletal disease, it would lead to more timely diagnosis and triage to rheumatologists for diagnosis and appropriate management. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has been developing evidence-based, practical and reliable criteria that can be used by clinicians to identify inflammatory musculoskeletal disease. The research initiative involves a sequential process of expert clinician nominal group technique, patient focus groups, and Delphi exercises to identify core definitive features of inflammatory disease. The goal is to develop simple clinical criteria (history and physical examination elements) to identify inflammatory arthritis, enthesitis, dactylitis, and spondylitis and distinguish these from degenerative, mechanical, or other forms of these conditions, to achieve more timely and accurate diagnosis and referral of patients with inflammatory arthritis.
Dactylitis
Inflammatory arthritis
Tenosynovitis
Spondyloarthropathy
Spondylitis
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