about a third of patients with psoriatic arthritis have oligoarticular, non-progressive disease and can be treated symptomatically or with intermittent intra-articular injections of steroids. However, it is identifying this group at an early stage that is the crux
adverse prognostic signs at presentation include:
polyarticular disease
previous steroid use (for any reason)
male sex
raised inflammatory marker such as the ESR or CRP
in this larger progressive group joint destruction will occur with time such that after 10 years significant impact on disability and quality of life will occur
in about 5% of people a rapidly advancing and destructive form of arthritis occurs with the end result being arthritis mutilans
mortality is increased in psoriatic disease with an increased prevalence of the metabolic syndrome and cardiovascular disease
for this reason identification and treatment of the usual risk factors for cardiovascular disease (obesity, smoking, hypertension, cholesterol) is important
people with psoriatic disease are also more likely to have liver abnormailties independent of alcohol use - this makes treatment with traditional agents such as methotrexate problematic, although not impossible
Reference:
(1) Arthritis Reasearch Campaign (2009). Hands On - Psoriatic arthritis: its presentation and management in primary care.
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