More likely seen in patients with severe cutaneous disease.
Concurrent psoriatic nail disease is more frequently noted.
Peripheral psoriatic arthritis may be indistinguishable from reactive arthritis (formerly known as Reiter syndrome).
There are five clinical patterns of psoriatic arthritis:
Asymmetric involvement of one or several small- or medium- sized joints—the most common initial presentation of psoriatic arthritis. Typically, the proximal or distal interphalangeal joints are affected and the result is sometimes referred to as a “sausage finger deformity” (Fig. 14.28).
Mild involvement of the distal interphalangeal joints—the classic form of psoriatic arthritis. Often accompanied by concomitant nail findings.
Symmetric joint involvement—difficult to distinguish from rheumatoid arthritis. However, the serologic test for rheumatoid factor is usually negative.
Involvement of the joints in the axial skeleton—resembles, and may overlap with, ankylosing spondylitis.
Mutilating, grossly deforming, arthritis of the hands (arthritis mutilans) (Fig. 14.29)—the least common presentation of psoriatic arthritis.
 Management
Goals of treatment are to decrease pain and prevent disease progression to maintain joint function. Treatment consists of analgesics, primarily nonsteroidal anti-inflammatory drugs, and systemic disease-modifying antirheumatic drugs (DMARDs). DMARDs that have shown efficacy for psoriatic arthritis include methotrexate, sulfasalazine, cyclosporine, anti-TNF- agents (e.g., infliximab, adalimumab, etanercept, golimumab, and certolizumab), and the anti-IL 12/23 antibody ustekinumab.
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