Psoriasis with Psoriatic Arthritis Clinical Examination

Summary

In this consultation, Dr. Thail examines a patient suffering from joint stiffness and pain, particularly in their hands. The patient describes stiffness, especially in the mornings and after tiring activities, affecting their fingers, wrists, and knees. They also mention difficulty performing tasks like unscrewing bottle lids and cooking. The patient has psoriasis and is being treated with Methotrexate, which has helped control the rash. The doctor assesses the patient's hands, noting tenderness and thin nails, and proceeds with a physical examination to evaluate joint movement. The patient shares family history of psoriatic arthritis and uses occasional anti-inflammatory medication.

Takeaways

• 😀 The patient, Dr. Thail, reports experiencing stiffness and pain in their hands, particularly in the morning and after periods of tiredness.
• 😀 One finger is significantly affected, showing limited movement and tenderness, with a similar issue developing in the adjacent finger.
• 😀 The stiffness lasts about an hour to an hour and a half in the mornings and worsens towards the end of the day due to fatigue.
• 😀 Both hands are affected, with wrist mobility also restricted. The patient experiences pain in multiple joints, including the knees and feet.
• 😀 Everyday tasks such as unscrewing bottle lids, peeling potatoes, and lifting pans are difficult for the patient due to hand pain.
• 😀 The patient has psoriasis and has been diagnosed with psoriatic arthritis, which has a family history, with a niece diagnosed at the age of 17.
• 😀 The patient is on Methotrexate, a medication to manage their condition, along with folic acid, and occasionally takes anti-inflammatory drugs.
• 😀 The patient has been on Methotrexate for just over a year and has noticed some relief in the psoriasis rash.
• 😀 The patient does not experience any redness or issues with their eyes, and there are no bowel problems like diarrhea.
• 😀 The patient reports having thin nails, particularly on one finger, which is a sign of their condition.
• 😀 The medical examination of the patient's hands does not cause significant pain, though certain areas are tender. The patient is able to perform some hand movements despite the discomfort.

Q & A

What condition is the patient likely suffering from?

The patient is likely suffering from psoriatic arthritis, as indicated by the joint pain, stiffness, and family history of similar conditions.

What specific symptoms does the patient report regarding their hands?

The patient reports stiffness, pain, and limited movement in their hands, particularly in one finger. The stiffness is more pronounced in the mornings and when fatigued.

How long does the morning stiffness last for the patient?

The morning stiffness lasts for about an hour to an hour and a half.

Which joints are affected in addition to the hands?

In addition to the hands, the patient also experiences issues with their knees, feet, and arm mobility.

What challenges does the patient face due to the joint pain?

The patient struggles with everyday tasks such as unscrewing bottle lids, peeling potatoes, lifting pans, and general kitchen activities.

What is the patient’s treatment plan for their condition?

The patient is on Methotrexate along with folic acid, which they take the next day. They also take anti-inflammatory medications as needed.

Has the patient experienced any other health issues?

Apart from their joint problems, the patient has psoriasis, which is under control with Methotrexate. They also mentioned small rashes on their neck and scalp.

Does the patient have any issues with their eyes or bowels?

No, the patient has not experienced any redness in the eyes or bowel complaints, such as diarrhea.

Has anyone in the patient’s family been diagnosed with a similar condition?

Yes, the patient has a niece who was diagnosed with psoriatic arthritis at 17, which is the same age the patient was diagnosed.

How is the patient’s psoriasis managed?

The patient manages their psoriasis with Methotrexate, which has helped calm down the condition.