Psoriatic arthritis

129 Psoriatic arthritis



Instruction


Examine this patient’s hands.



Salient features



History




• Cutaneous psoriasis with itching in a fifth of the patients


• Joint pain, joint stiffness worse in the morning.



Examination




• Distal interphalangeal joint involvement.


Proceed as follows:



• Tell the examiner that you would like to:


• examine the nails, looking for pitting, onycholysis, discoloration, thickening (nails are involved in 80% of patients with psoriatic arthritis)

• look for psoriatic plaques in the extensor aspects of elbows, scalp, submammary region, umbilicus and natal cleft; describe these as reddish plaques with well-defined edges and silvery white scales (Fig. 129.1).

• Comment on the fingers, which are sausage shaped because of tenosynovitis (Fig. 129.1).


image

Fig. 129.1 Psoriatic arthritis, with asymmetric arthritis pattern.


(With permission from Habif 2009.)



Diagnosis


This patient has nail pitting, psoriatic plaques and distal interphalangeal arthropathy (lesion) caused by psoriasis (aetiology) and has good hand function (functional status).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Psoriatic arthritis

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