Psoriatic arthritis. Diverse and sometimes highly destructive.

Psoriatic arthritis is an inflammatory arthritis with diverse clinical manifestations. Certain subsets of patients tend to run a more severe course of erosive disease. A few points are noteworthy: When a diagnosis of psoriatic arthritis is being considered, ask if there is any family history of psoriasis and search for skin lesions in all parts of the body, including the scalp, ears, and genital and anal areas. Rule out septic arthritis even in a patient with an established diagnosis of psoriatic arthritis, especially if the presentation is monarticular. In cases of fulminant disease, consider checking for HIV infection. Pharmacologic therapy and physical rehabilitation are used in psoriatic arthritis. Mild cases can be controlled with use of nonsteroidal anti-inflammatory drugs; in more severe cases, treatment with immunosuppressive or disease-modifying agents is needed.