Psoriatic arthritis is an inflammatory arthritis associated with

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					Picture Test- 62 Answer: Methotrexate Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. It is considered as a part of seronegative arthropathies. The presence of an inflammatory arthritis in a patient with psoriasis makes the diagnosis likely. However, not all patients with psoriasis and arthritis have psoriatic arthritis. As an example, patients with psoriasis may have coexistent rheumatoid arthritis, osteoarthritis, arthritis of inflammatory bowel disease, and gout. In addition to the characteristic features of an inflammatory arthritis Psoriatic arthritis has, stress pain, joint line tenderness, and effusions in the affected joints, often in an asymmetric distribution. The distal interphalangeal joints and spine are each affected in 40 to 50 percent of cases. Distal arthritis, characterized by involvement of the distal interphalangeal (DIP) joints, Asymmetric oligoarthritis, Symmetric polyarthritis, Arthritis mutilans and Spondyloarthropathy, including both sacroiliitis and spondylitis can be seen. Enthesitis and Tenosynovitis can also be seen. Dactylitis is characterized by diffuse swelling of a whole digit (called "sausage finger" or toe). It occurs in nearly onehalf of patients with psoriatic arthritis and is associated with an increased risk of progressive radiographic joint damage. This abnormality is thought to result from inflammation of soft tissues, including the tendon sheaths, and from the concomitant inflammation of the adjacent joints. This finding is suggestive of psoriatic arthritis. The nail lesions in psoriatic arthritis, pits and onycholysis, are indistinguishable from those in uncomplicated psoriasis. Although the extent of skin disease in general has not correlated with the degree of joint disease, the severity of psoriatic nail involvement correlates closely with the extent and severity of both skin and joint disease and is more common in those with distal interphalangeal arthritis. Arthritis precedes the skin disease in approximately 13 to 17 percent of cases and skin lesion are present but have not been diagnosed in an additional 15 percent. Radiological damage was observed in two-thirds of patients at their first visit and the radiographic finding showed in the picture called- “pencil in a cup” pattern is very suggestive of Psoriatic arthritis. Despite the lack of randomized controlled trials showing efficacy, methotrexate is the most commonly used drug in clinical practice and has been shown to improve both the joint and skin manifestations of psoriasis

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