**Part 2**

**Clinical Presentation** 

62 Psoriasis

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**5** 

Peter Härle

*Germany* 

*An der Goldgrube 11, Mainz* 

**Detecting Psoriasis Arthritis Early in the** 

**Can Successfully Cooperate?** 

**Spinal manifestations Extra-articular Manifestations** 

Bony ankylosis Periodontitis with dental loss

**Disease Course – Why This is Important and** 

*Katholisches Klinikum Mainz, Klinik für Rheumatologie und Physikalische Therapie* 

Psoriatic arthritis (PsA) was first recognized as a specific rheumatic entity in 1964 by the American Rheumatism Association (later American College of Rheumatology) (Blumberg, 1964). In the forthcoming years it has become clear that PsA belongs to the spondyloarthritis (SpA) family that comprises several heterogeneous clinical conditions. These are Ankylosing Spondylitis, Reactive Arthritis (which occurs after bacterial infections), Spondyloarthritis associated to Chronic Inflammatory Bowel Diseases (Crohn´s disease and Ulcerative Colitis), Undifferentiated Spondyloarthritis, and juvenile forms (figure 1). The term spondyloarthritis relates to inflammatory manifestations of peripheral and spinal joint structures. The Spondyloarthitides are defined by classification criteria (Sieper, 2009; Zeidler 2011, Rudwaleit 2011). The main clinical manifestation will trigger the main group for each disease entity may have varying degrees of articular, spinal, and extraaticular manifestations. Furthermore, extraarticular inflammatory manifestations may also occur at different intensity levels. However, it needs to emphasized that classification criteria are not diagnostic criteria. Classification criteria were developed for clinical studies in order to include rather homogenous disease manifestations. In daily clinical practice it may occur that although the classification criteria are not fully met, the patient still may be allocated to

Arthritis Spondylitis Uveitis, Scleritis, Conjunctivitis

Tendosynovitis Facet joint arthritis Inflammatory bowel disease

Table 1. Clinical manifestation of the Spondyloarthritides, which may be present in all the

Enthesitis Enthesitis Psoriasis Bursitis Sacroiliac joint arthritis Urethritis

**1. Introduction** 

a certain disease entity.

Erosive-proliferative joint

different disease entities (Fig. 1).

**Peripheral joint manifestations** 

destruction

**How Dermatologists and Rheumatologists** 
