Model of pathogenesis of psoriasis. Part 1. Systemic psoriatic process. Edition e4.0.
Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.
-
Upload
timothy-daniel -
Category
Documents
-
view
239 -
download
5
Transcript of Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.
![Page 1: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/1.jpg)
Pathophysiology
PsoriasisPsoriatic Arthritis
Cellulitis
![Page 2: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/2.jpg)
![Page 3: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/3.jpg)
aps
![Page 4: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/4.jpg)
nerps
![Page 5: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/5.jpg)
![Page 6: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/6.jpg)
aps
![Page 7: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/7.jpg)
PSORIATIC ARTHRITIS
![Page 8: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/8.jpg)
An inflammatory arthritis that occurs in a patient with psoriasis.
Harrison’s Internal Medicine 17th edition
A form of arthritis that occurs in patients with psoriasis with the hallmarks of an "inflammatory" arthritis, including joint pain, erythema, and swelling, often
with prominent stiffness. Mease, P., Menter, A. (2005) , Psoriatic Arthritis: Understanding Its Pathophysiology and Improving Its
Diagnosis and Management. Retrieved from: http://cme.medscape.com/viewarticle/509053
![Page 9: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/9.jpg)
Clinical Features
• Unique to Psoriatic Arthritis:– DIP joint involvement– Nail changes – Dactylitis – Enthesitis– Spondylitis Lytic and periarticular new bone
formation x-ray features – Iritis or Uveatis
Mease, P., Menter, A. (2005) , Psoriatic Arthritis: Understanding Its Pathophysiology and Improving Its Diagnosis and Management. Retrieved from: http://cme.medscape.com/viewarticle/509053
![Page 10: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/10.jpg)
Clinical Features
• Patterns of Arthropathy1. Arthritis of DIP joints2. Asymmetric oligoarthritis3. Symmetric polyarthritis4. Axial involvement5. Arthritis Mutilans
![Page 11: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/11.jpg)
Psoriatic Arthritis
Distal Interphalangeal joint arthritis
• Occurs in 15 % of cases• Nail changes also seen
Harrison’s Internal Medicine 17th edition
![Page 12: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/12.jpg)
Psoriatic Arthritis
• Asymmetric Oligoarthritis• Involves the knee or any large joint
with a few small joints in the fingers and toes– Metarsophalangeal– Proximal interphalengeal– Distal interphalengeal
• Dactylis– Sausage shaped digits due to inflammation of
the flexor tendons and synovium and pitting edema of the distal extremities may be observed
Harrison’s Internal Medicine 17th edition
![Page 13: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/13.jpg)
Psoriatic Arthritis
Symmetric polyarthritis• Affects the Hands, wrists, knees,
and feet symmetrically– Proximal interphalangeal joints– Metacarpophalangeal joints
• Peripheral joints are less tender compared to RA
Harrison’s Internal Medicine 17th edition
![Page 14: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/14.jpg)
Psoriatic Arthritis
Axial Arthropathy • Spine and sacroiliac
joints
Harrison’s Internal Medicine 17th edition
![Page 15: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/15.jpg)
Psoriatic Arthritis
Arthritis mutilans• Widespread shortening or
telescoping of digits due to osteolysis of the phalanges and metacarpals
• coexisting with ankylosis and contractures in other digits
• opera-glass deformity or pencil-in-cup radiographic findings
• Fever
Harrison’s Internal Medicine 17th edition
![Page 16: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/16.jpg)
Nail Changes
• Pitting• Horizontal ridging• Onycholysis• Discoloration of nail
margins• Dystrophic
hyperkeratosisOnycholysis
Nail pitting
OnychodystrophyHarrison’s Internal Medicine 17th edition
![Page 17: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/17.jpg)
Dactylitis
Involvement of the distal and proximal interphalangeal joints, together with tendon
sheath involvement, may give the digit a sausage shape
Harrison’s Internal Medicine 17th edition
![Page 18: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/18.jpg)
Enthesitis
Inflammation at the sites of ligamentous and tendinous insertions
Emedicine Retrieved from: http://emedicine.medscape.com/article/1108557-overview
![Page 19: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/19.jpg)
Risk Factors:•Immunocompromised due to meds•Auspitz sign – break in skin integrity
![Page 20: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/20.jpg)
Psoriasis
Cellulitis
Indigenous flora colonizing the skin
Staphylococcus aureusStreptococcus
pyogenesExogenous bacteria
Indigenous flora colonizing the skin
Staphylococcus aureusStreptococcus
pyogenesExogenous bacteria
Harrison’s Principles of Internal Medicine 17th ed.
![Page 21: Pathophysiology Psoriasis Psoriatic Arthritis Cellulitis.](https://reader033.fdocuments.net/reader033/viewer/2022061305/5513f27d5503463a298b60b3/html5/thumbnails/21.jpg)
Cellulitis• At the involved site
– Localized pain– Erythema – Swelling– Warmth– Borders are not sharply
demarcated
• Fever and chills• Malaise
Harrison’s Principles of Internal Medicine 17th ed.