 What is up YouTube, welcome back to my channel. A lot of you guys may be wondering why there is a picture of Kim Kardashian as my thumbnail. And here's why. Last week I was watching Keeping Up with the Kardashians, I mean my wife was watching Keeping Up with Kardashians and I just was listening to it in the background. But anyways, in that episode Kim Kardashian was experiencing some arthritic type symptoms in her hands and she was concerned for some sort of autoimmune induced arthritis, which in someone with known psoriasis, we would be concerned for psoriatic arthritis. I would have never in a million years thought that Keeping Up with the Kardashians would provoke me to do a video on psoriatic arthritis, but that is exactly what we're talking about in this video. And I will obviously be including some radiologic findings as well. So let's get into it. Psoriasis is an immune-mediated disease that can cause raised, red, scaly patches or plaques to appear on the skin. It usually affects the extensor regions of major joints such as the elbows, knees, and even the scalp. While we aren't entirely sure what causes psoriasis, we do know that immune system and genetics plays a major role in the development. And the disease usually develops between ages 15 and 35, but can really develop at any age. It is not a contagious disease, which means you cannot catch it from other people. There are currently no special tools or specific blood tests to diagnose psoriasis, but a dermatologist can examine the skin and determine if it looks like psoriasis or not. The typical skin appearance of psoriasis looks something like this. Now let's talk about arthritis associated with psoriasis, which is exactly what Kim Kardashian was worried about in the TV show. Usual symptoms of psoriatic arthritis can vary from person to person, but can range anywhere from mild to severe. General symptoms can include swollen, tender joints on one or both sides of your body, burning stiffness, swollen fingers and toes, painful muscles and tendons, scaly skin patches which made worse when joint pain flares up, nail pitting, etc. So how are radiologists useful in diagnosing psoriasis? Well we aren't really useful in diagnosing the skin manifestations, but we are really useful in diagnosing the arthritic manifestations. We do this by looking at x-rays of the bones and joints of the body. Psoriatic arthritis has a very classical appearance on x-ray, which is exactly what we will get into right now. Let's go. I'm going to show you guys a list of the most common imaging findings that we see, and I will show you a picture of normal joints so you guys can see the difference. So let's first start off with a normal x-ray of the right hand. Here you can see normal joint spaces between the interphalangial joint. This is the distal interphalangial joint, the proximal interphalangial joint, and the metatarpal phalangial joint. As you can see, there's nice joint spaces, nice smooth margins around the bases, and no soft tissue swelling around the fingers. So let's start with our first manifestation of psoriatic arthritis. This is what we like to call a sausage digit, or dactylitis. As you can see here, there is swelling of multiple fingers of the right hand, most pronounced in the middle finger here, where there is extensive soft tissue swelling around the entire finger. Now let's go back to the normal example of the right hand so you can see the difference. Here we see these swelling at the end around the fingers, also called dactylitis. But as you can see over here in the normal right hand, there is no swelling, you can barely make out the soft tissues as they hug the bones nicely. And this is what you would see in a severe case of dactylitis on physical examination. So you can see how there's marked swelling around the fingers, which correlates to our radiographic findings as well. The next common imaging finding we see is called pencil and cup deformity. This is caused by inflammation of the ligamentus or tendinous attachment to bone as well as marginal erosions. So as you can see of this right middle finger again, you can see there's a nice pointed deformity, which we would call a pencil, and there's erosion of the distal failing space, which is what we call a cup. So it looks like a pencil going into a cup. You can see it again over here with a nice cup deformity here, but not as good of a pencil deformity, and again on the right thumb down here. Again, I'll compare it to a normal one so you guys can see the difference. So we have pencil and cup deformity up here. As you can see here, this is a normal hand with normal joint spaces and no marginal erosions or pencil and cup deformities. And here we just have a severe example of psoriatic arthritis involving the feet. Now there are obviously many radiographic manifestations of psoriatic arthritis, but I just wanted to touch on a few of the most common findings we usually see and especially what we tend to see on our board exams. So hopefully that will help you guys out. So how is psoriatic arthritis usually treated? Well, it's usually treated with non-steroidal anti-inflammatory drugs, also called NSAIDs, for example, Advil or Naproxen. However, if disease is severe, we can use disease modifying anti-rheumatic drugs, also known as DMARDS, such as methotrexate, or we can even use newer biologic agents such as Humira, which can be very useful. All right, so now you guys know everything about psoriasis and psoriatic arthritis and why Kim Kardashian was so concerned that she may be dealing with this manifestation of psoriasis. I hope you guys enjoyed this video. As always, make sure you smash that like and subscribe button. Follow me on Instagram if you don't already. Leave me a comment below if you want me to do more videos like this. Otherwise, see you guys on the next video.