Concluded Case

Psoriatic Arthritis

23 year old wit a h/o scalp Psoriasis undergoing treatment complains of pain and swelling of left hand MCP joint and proximal phalangeal joint, bilateral knee pain and right shoulder paim with limited mobility. Complains of morning stiffness of the affected joints. No h/o any injury in the past. No allergies. Started with Etorcoxib 60mg BD RF: 19.2 Anti CCP negetive ESR: 10 Psoriatic Arthritis?!

1 Like

LikeAnswersShare
Concluded answer
Psoriasis proceeds arthritis in 80% of cases. Onset of arthritis lags by upto 2 yrs. Arthritis is 5 times more common with sever skin lesion then mild illness. Asymmetric joint involvement Distal inter phalangeal (DIP) are primarily affected Uric acid level may be in upper normal limit become of high active turnover of skin cells but correlation with gout is less Rx NSAIDs Methotrexate (7.5-20mg/week) with folic acid Steroids - less effective
All Answers
Psoriasis proceeds arthritis in 80% of cases. Onset of arthritis lags by upto 2 yrs. Arthritis is 5 times more common with sever skin lesion then mild illness. Asymmetric joint involvement Distal inter phalangeal (DIP) are primarily affected Uric acid level may be in upper normal limit become of high active turnover of skin cells but correlation with gout is less Rx NSAIDs Methotrexate (7.5-20mg/week) with folic acid Steroids - less effective
Thank you doctor
0
Psoriatic arthritis Because of 1) Asymmetric affection of joints in psoriatic arthritis where as in rheumatoid arthritis joints of both limbs are symmetrically affected 2) RA factor and anti CCP antibody negative 3) Psoriatic lesions present on scalp
Thank you doctor
0
The asymmetrical involvement of multiple joints indicates the case is not RA, though there is morning stiffness and small joint involvement. The diagnosed psoriatic lesion on scalp is the prior indication towards PsA.
Valuable opinion
1

View 1 other reply

Psoriatic arthropathy likely. Treatment in lines of inflammatory arthritis Long term treatment in consultation with a rheumatologist Physiotherapy
Put patient on Methotrexate 7.5mg once a week+Tab Folic acid 5mg daily   for next 45days Continue with Etoricoxib
Thank you doctor
0
Possibly gout uric acid 5 point 5 febustat40 mg od dd psoriatic arthritis
Thank you doctor
0
Sero negative RA
Thank you doctor
0
Nice case
Thank you doctor
0

Cases that would interest you