Psoriatic Arthritis

Wahyuddin*. Mahriani Sylvawani**

*Resident of Internal Medicine, Medical Faculty of Syiah Kuala University
**Division of Rheumatology, Departments of Internal Medicine, School of Medicine
Syiah Kuala University, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
Introduction
Psoriasis approximately 2% of the population1. Psoriatic arthritis (PsA) is a chronic
inflammatory arthropathy affecting up to 40% of patients with skin or nail psoriasis. It is
considered a type of seronegative spondyloarthropathy and can cause arthritis, enthesitis,
dactylitis and axial inflammation2. Reported a man, 47 years old with skin rash
accompanied pain in the joint of the hands and feet. Medical history was significant for
psoriasis of more than 3 years duration, He also experienced prolonged morning stiffness.
Rheumatoid factor was within normal limits. In the hand radiographic examination was
perform extensive deformities were noted involving all the digits. The bone of humerus
relatively spared from radius-ulna. Radiographs of the feet showed the first
metatarsophalangeal joint in both feet were narrowed and showed articular erosions.
Methods
Case report
Result
The patient was diagnosed as Psoriatic arthritis (PsA) and was treated by
dermatologist with steroid topical before. We gave steroid oral, folic acid, omeprazole and
calsium than continue with methotrexate. The patients pain and stiffness in the digits were
relieved dramatically after 10 days hospitalized.
Discussion
The CASPAR (classification criteria for PsA) have a specificity of 98.7% and
sensitivity of 91.4% for diagnosing PsA 3. The man has 6 points and established as PsA
with CASPAR criteria. Based on the available literature, the patient with inconvinience
living and physical/mental functions or lack of response to NSAIDs classified as moderate
PsA and should be started on DMARD (disease modifying antirheumatic drugs). The
experts recommended methotrexate as the first choice DMARD. Methotrexate is frequently
used as the primary DMARD in PsA, because of its efficacy in treating both skin and joint
involvement in patients with Psoriasis disease and its low cost.
Key Words: Psoriasis arthritis, DMARD, The CASPAR
Reference
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