Abstract
Psoriatic arthritis is a chronic inflammatory arthritis that affects about 5–25% of patients with psoriasis. The prevalence varies from 20–420 per 100,000 population across the world except in Japan where it is 1 per 100,000. Psoriatic arthritis affects both genders equally and in more than half it follows long-standing psoriasis. Psoriatic arthritis has been grouped into five subtypes: distal interphalangeal (DIP) predominant, symmetrical polyarthritis, asymmetrical oligoarthritis and monoarthritis, predominant spondylitis, and arthritis mutilans. Oligoarthritis occurs in nearly 60% during early disease but later polyarticular disease predominates mainly due to evolution of oligoarthritis to polyarthritis. In 50–60% polyarthritis is symmetrical. Dactylitis and enthesopathy are other major features seen in nearly one third of patients. The diagnosis of psoriatic arthritis is easy in the presence of typical skin lesions, however it can also be made in absence of skin lesions using Classification of Psoriatic Arthritis criteria. Though 30–40% of patients develop joint deformities at a follow-up of 5–10 years but most retain good functional status. Clinical damage has a strong relationship with number of swollen joints, erythrocyte sedimentation rate, and duration of arthritis. Radiological damage occurs early and erosions are present in nearly 50% at 10 years of disease. Spinal disease also has good outcome with maintained spinal mobility in majority of the patients. Screening of patients with psoriasis using questionnaire can help in early diagnosis. Nail dystrophy, scalp lesions, and intergluteal/perianal psoriasis are associated with higher chance of development of psoriatic arthritis. Early diagnosis will lead to early treatment and better outcome especially with advent of new drugs.
Similar content being viewed by others
References
Neil T, Silman AJ (1994) Psoriatic arthritis. Historical background and epidemiology. Ballieres Clin Rheumatol 8:245–261
Alamanos Y, Voulgari PV, Drosos AA (2008) Incidence and prevalence of psoriatic arthritis. A systematic review. J Rheumatol 35:1354–1358
Hukuda S, Miami M, Saito T et al (2001) Spondyloarthropathies in Japan: nationwide questionnaire survey performed by the Japan Ankylosing Spondylitis Society. J Rheumatol 28:554–559
Zeng QY, Chen R, Darmavan J et al (2008) Rheumatic diseases in China. Arthritis Res Ther 10:R17
Thumboo J, Tham SN, Yk T et al (1997) Pattern of psoriatic arthritis in Orientals. J Rheumatol 24:1943–1953
Tam LS, Leung YY, Li EK (2009) Psoriatic arthritis in Asia. Rheumatology (Oxford) 48:1473–1477
Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM (2009) Time trends in epidemiology and characteristics of psoriatic arthritis over 3 decades: a population-based study. J Rheumatol 36:361–367
Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM (2009) Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum 61:233–239
Gladman DD, Shuckett R, Russell ML et al (1987) Psoriatic arthritis. An analysis of 220 patients. Q J Med 62:127–141
Jones SM, Armas JB, Cohen MG, Lovell CR, Evison G, McHugh NJ (1994) Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease. Br J Rheumatol 33:834–839
Rajendran CP, Ledge SG, Rani KP, Madhavan R (2003) Psoriatic arthritis. J Assoc Physicians India 51:1065–1068
Torre Alonso JC, Rodriguez Perez A, Arribas Castrillo JM et al (1991) Psoriatic arthritis: a clinical, immunological and radiological study of 180 patients. British J Rheumatol 30:245–250
Zisman D, Eder L, Elias M, Laor A, Bitterman H, Rozenbaum M, Feld J, Rimar D, Rosner I (2010) Clinical and demographic characteristics of patients with psoriatic arthritis in northern Israel. Rheumatol Int. doi:10.1007/s00296-010-1673-1
Madland TM, Apalset EM, Johannessen AE, Rossebö B, Brun JG (2005) Prevalence, disease manifestations, and treatment of psoriatic arthritis in Western Norway. J Rheumatol 32:1918–1922
Michet CJ, Mason TG, Mazlumzadeh M (2005) Hip joint disease in psoriatic arthritis: risk factors and natural history. Ann Rheum Dis 64:1068–1070
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673
Noosent JC, Gran JT (2009) Epidemiological and clinical characteristics of psoriatic arthritis in northern Norway. Scand J Rheumatol 38:251–255
Moll JMH, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3:55–78
Vasey FB, Espinoza LR (1984) Psoriatic arthritis. In: Calin A (ed) Spondyloarthropathies. Grune and Stratton, Orlando, pp 151–185
Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivieri I, Pasero G et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227
McGonagle D, Conaghan PG, Emery P (1999) Psoriatic arthritis: a unified concept twenty years on. Arthritis Rheum 42:1080–1086
Fournié B, Crognier L, Arnaud C, Zabraniecki L, Lascaux-Lefebvre V, Marc V et al (1999) Proposed classification criteria of psoriatic arthritis. A preliminary study in 260 patients. Rev Rhum Engl Ed 66:446–456
Chandran V, Schentag CT, Gladman DD (2007) Sensitivity of the classification of psoriatic arthritis criteria in early psoriatic arthritis. Arthritis Rheum 57:1560–1563
Veale D, Rogers S, Fitzgerald O (1994) Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol 33:133–138
Roberts MET, Wright V, Hill AGS, Mehra AC (1976) Psoriatic arthritis: follow up study. Ann Rheum Dis 35:206–212
Reich K, Krüger K, Mössner R, Augustin M (2009) Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol 160:1040–1047
Chandran V, Barrett J, Schentag CT, Farewell VT, Gladman DD (2009) Axial psoriatic arthritis: update on a longterm prospective study. J Rheumatol 36:2744–2750
Punzi L, Pianon M, Rossini P, Schiavon F, Gambari PF (1999) Clinical and laboratory manifestations of elderly onset psoriatic arthritis: a comparison with younger onset disease. Ann Rheum Dis 58:226–229
Battistone MJ, Manaster BJ, Reda DJ, Clegg DO (1999) The prevalence of sacroilitis in psoriatic arthritis: new perspectives from a large, multicenter cohort. A Department of Veterans Affairs Cooperative Study. Skeletal Radiol 28:196–201
Helliwell PS, Porter G, Taylor WJ, CASPAR Study Group (2007) Polyarticular psoriatic arthritis is more like oligoarticular psoriatic arthritis, than rheumatoid arthritis. Ann Rheum Dis 66:113–117
Williamson L, Dalbeth N, Dockerty JL et al (2004) Nail disease in psoriatic arthritis—clinically important, potentially treatable and often overlooked. Rheumatol (Oxford) 43:690–691
Brockbank JE, Stein M, Schentag CT, Gladman DD (2005) Dactylitis in psoriatic arthritis: a marker for disease severity? Ann Rheum Dis 64:188–190
Gladman DD, Chandran V (2011) Observational cohort studies: lessons learnt from the University of Toronto Psoriatic Arthritis Program. Rheumatol (Oxford) 50:25–31
Kane D, Gearney T, Bresnihan B, Gibney R, Fitzgerald O (1999) Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheumatol 25:1746–1751
Lambert JR, Wright V (1976) Eye inflammation in psoriatic arthritis. Ann Rheum Dis 35:354–356
Queiro R, Belzunegui J, González C, De DJ, Sarasqueta C, Torre JC et al (2002) Clinically asymptomatic axial disease in psoriatic spondyloarthropathy. A retrospective study. Clin Rheumatol 21:10–13
Bond SJ, Farewell VT, Schentag CT, Gladman DD (2007) Predictors for radiological damage in psoriatic arthritis: results from a single centre. Ann Rheum Dis 66:370–376
Siannis F, Farewell VT, Cook RJ, Schentag CT, Gladman DD (2006) Clinical and radiological damage in psoriatic arthritis. Ann Rheum Dis 65:478–481
Sokoll KB, Helliwell PS (2001) Comparison of disability and quality of life in rheumatoid and psoriatic arthritis. J Rheumatol 28:1842–1846
Zachariae H, Zachariae R, Blomqvist K, Davidsson S, Molin L, Mork C et al (2002) Quality of life and prevalence of arthritis reported by 5795 members of the Nordic Psoriasis Associations. Data from the Nordic Quality of Life Study. Acta Derm Venereol 82:108–113
Husted JA, Gladman DD, Farewell VT, Long JA, Cook RJ (1997) Validating the SF-36 health survey questionnaire in patients with psoriatic arthritis. J Rheumatol 24:511–517
Anandrajah AP, Ritchlin CT (2009) The diagnosis and treatment of early psoriatic arthritis. Nat Rev Rheumatol 5:634–641
Gladman DD, Schentag CT, Tom BD, Chandran V, Brockbank J, Rosen C, Farewell VT (2009) Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (ToPAS). Ann Rheum Dis 68:497–501
Ibrahim GH, Buch MH, Lawson C, Waxman R, Helliwell PS (2009) Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire. Clin Exp Rheumatol 27:469–474
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dhir, V., Aggarwal, A. Psoriatic Arthritis: a Critical Review. Clinic Rev Allerg Immunol 44, 141–148 (2013). https://doi.org/10.1007/s12016-012-8302-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12016-012-8302-6