Psoriatic Arthritis

sophie_sophie899
Mind Map by sophie_sophie899, updated more than 1 year ago
sophie_sophie899
Created by sophie_sophie899 over 6 years ago
13
1

Description

podiatry

Resource summary

Psoriatic Arthritis
  1. Aetiology
    1. Exact cause unknown, research suggests something (infection?) acts as a trigger in people who are susceptible to this arthritis
    2. Pathology
      1. PsA is an inflammatory arthritis associated with psoriasis. symptoms range from mild to severe - the typical rheumatic symptoms being joint stiffness, pain and swelling, and tenderness of ligament and tendon insertions. Although traditionally perceived as a mild disorder, about 2/3rds of people with PsA have progressive, damaging arthritis.
      2. Diagnostic criteria (> 6 for PsA)
        1. Back pain at night or stiffness in the morning (1)
          1. Asymmetric oligoarthritis (2)
            1. Gluteal pain without other details (1) or Alternating gluteal pain (2)
              1. Sausage digit or toe (2)
                1. Heel pain or other enthesopathy (2)
                  1. Iritis (2)
                    1. Diarrhoea within 1 month onset of arthritis (1)
                      1. Sacroiliitis (3)
                        1. Presence of HLA-B27 antigen and/or positive family Hx of AS, ReA, psoriasis, uveitis or chronic bowel disease (2)
        2. Treatment
          1. Medical management Control Inflammation
            1. Pain management
              1. Analgesics
              2. NSAIDS
                1. DMARDS (Sulfasalazine & Methotrexate) if not responding to 2 either in combination or alone use cheapest biologic
                  1. Biologic therapy
                    1. Review in 12 weeks for improvement of: Atleast 2/4 PsARC criteria(1 of which has to be joint tenderness and swelling score) & no worsening in any of 4 criteria.
                      1. If Pt has no response to PASI (Psoriasis Area and Severity Index) Discontinue Anti-TNF inhibitor used
                2. Surgery
                  1. Podiatric management
                    1. Foot orthoses
                      1. Active enthesitis (Offload areas)
                        1. Tenosynovitis particularly Tib post (Medial heel wedge)
                          1. Poor rear foot alignment, low MLA, residual foot impairments even when disease activity has been suppressed (offload/realign accordingly)
                          2. Skin/Nail/ Lesion care/ Self management, Hygiene advice
                            1. Footwear advice
                              1. Excercises
                                1. Strengthening muscles eg Tib post
                                  1. Stretches
                                  2. IA Steroids
                                    1. Tx for Dactlyitis/ Enthesitis
                                    2. Long term Mx
                                      1. Decrease foot pain, increase physical function, increase Health related QoL
                                  3. Differential diagnosis
                                    1. MSK conditions
                                      1. PF
                                        1. AT
                                          1. Tib Post
                                          2. Nails
                                            1. Fungal
                                              1. O/X
                                              2. Other seronegative spondylarthropathy (AS)
                                              3. Referralls
                                                1. Orthotist
                                                  1. Assessment of biomechanical deficits (Functional problems)
                                                    1. Design, manufacture, delivery & review of orthotses (orthopaedia aids) and footwear
                                                    2. General practitioner
                                                      1. First contact
                                                        1. Diagnosis/referral
                                                          1. Initiate treatment
                                                            1. Long-term condition/co-morbidities management
                                                            2. Occupational therapist
                                                              1. Maintaining activities of daily living
                                                                1. Education, with provision of aids and coping skills
                                                                2. Physiotherapist
                                                                  1. maintaining functional ability
                                                                    1. musculoskeletal assessment
                                                                      1. pain management and patient education
                                                                    2. Assessment
                                                                      1. Peripheral joint assessment
                                                                        1. 66/68 tender/swollen joint count
                                                                          1. DAS
                                                                            1. PSARC
                                                                              1. ACR response criteria
                                                                              2. Enthesitis assessment
                                                                                1. Leeds enthesitis Index (LEI)
                                                                                  1. 6 sites: Bilateral AT insertions, Bilateral medial femoral condyles, Bilateral lateral epicondyles of the humerus
                                                                                2. Dactylitis assessment
                                                                                  1. Leeds dactylitis index (LDI)
                                                                                    1. 0-3Scale. 0=no tenderness. 1= tender. 2= tender + wince. 3= tender + withdraw
                                                                                Show full summary Hide full summary

                                                                                Similar

                                                                                Radiographic Image Interpretation Flashcards
                                                                                fliss29
                                                                                Pharmacology Drug Flashcards
                                                                                fliss29
                                                                                Pod Med 1 quiz
                                                                                neda218
                                                                                Intoeing Gait
                                                                                sophie_sophie899
                                                                                PSA 560 Subsequent Events
                                                                                Irene Eloisa
                                                                                8: Audit in Government
                                                                                Nazyrah Shahidi
                                                                                Test PSA
                                                                                greghobson99
                                                                                Program Strategic Alignment
                                                                                Vanita Anchan
                                                                                Radiographic Image Interpretation Flashcards
                                                                                Jacob Wolfrum
                                                                                Pharmacology Drug Flashcards
                                                                                Etomby Namme