60 year old male presented with brittle nails on fingers of both hands and toes. He also gives a h/o pain in b/l elbow joints, b/l knee joints pain and swelling in the proximal phalanges of both hands ,describes as inability to close fist. No significant h/o any past medical illness. No skin manifestations seen. Xray of both hands done, images attached. Blood sample sent for CBC, ESR, Anti CCP, RA factor. For the timing, NSAIDS PPI and VIT D has been prescribed and Follow up adviced with reports. D/d: Psoriasis Rheumatoid arthritis Onchomycosis

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1..Nail psoriasis.. It is often accompanies other forms of the disease because the nails are part of the skin. They grow from the nail root, which is under the cuticle, and psoriasis can form in the nail root. Signs of psoriatic nails include: pitting, which involves dents or holes forming in the nail. white spots on the nail. 2.Hand osteoarthritis .. It is inflammation that causes pain and stiffness in your joints. It usually happens in three places: The base of your thumb, where it meets your wrist. One of the joints closest to your fingertips. Topical corticosteroids...../ Adalimumab... For OA...NSAID../ Surgery

Thank you sir..
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From history polyartheralgia involving smaller as well as major joints with difficulty in fisting bcz of stiff joints Nails do shows onicomycosis ?psoriasis Continue the treatment given It appears to be mostly a c/o RA

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Osteolytic areas with osteosclrotic areas are seen ? Osteodystrophy Renal function may be checked . DD Psoriatic arthropathy with psoriatic nail dystrophy RA Onychomycosis Blood results will give probable diagnosis. Paring of nail may be sent for KOH test.

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? NAIL PSORIASIS.. ? ONYCHOMYCOSIS.. WITH.. ARTHROPATHY.. NEED'S CLINICOPATHOLOGICAL EVALUATION WITH.. BLOOD CBC.. ANEMIA PROFILE.. TFT ..

Thank you sir, blood sample has been sent
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Considering age and x rax shows can b osteoporosis Nail fungal infection causing brttleness PSA S ca S vitd3 Bone density test R needed with above tests

Thank you sir..
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Classic psoriatic arthritis Nail psoriasis Dactylitis X ray showing periostitis with features of inflammatory arthritis Nice case

Rule out rheumatoid and seronegative arthopathy. All the investigations as you advised Get additional blood sugar profile as more of then nought these patients require a dose of steriod therapy.

Thank you sir..
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Onychomycosis Adv Terbinafine tablet 250 mg one tablet daily for 3 months Terbinafine ointment for local application

Osteoarthritis in the hand,britttle nail in the sole,Adv thyroid profile,

Thank you Dr Bhaswati pathak
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