Diagnosing Psoriatic Arthritis: A Real-World Case

Announcer:

This is Living Rheum on ReachMD. On this episode, we’ll hear from Dr. Lawrence H. Brent, who’s a Professor of Medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia. He’ll be sharing a patient case of psoriatic arthritis.

Here’s Dr. Brent now.

Dr. Brent:

So, psoriatic arthritis, by the time the patient gets to me, isn't usually that difficult, but it can be. One patient, I remember, and I often use this case in a lecture, she was a young woman. She comes in to see me. She's had maybe two or three months of pain and swelling in a few joints in her hands, a few joints in her fingers and in her toes. She tried taking Aleve, and it didn't really help.

And so she came in, and we're looking at her joints, and it's this asymmetric arthritis that's one of the patterns of psoriatic arthritis. And then I asked her, "Do you have any skin rashes?" And she says no. But she goes, "I have this itchy thing on my back of my head." So I took a look, pulled her hair apart, and then I saw that there was a little psoriatic patch. And then I asked her to pull up her shirt and looked in her belly button, and there was a little psoriasis in the belly button.

So these are two places that people don't usually look. She can't really see the back of her head, but the other places psoriasis likes are the elbows—sort of the point of the elbows—the top of the knees, and even just above your butt crack.

So again, that would be something that a patient would have trouble seeing that themselves. And so you just have to be aware that sometimes the psoriasis isn't that dramatic. And in some cases, the arthritis can occur before the skin disease, so that makes it a little more challenging. And that's more common in children, so the pediatric rheumatologists see this more than the adults.

Announcer:

That was Dr. Lawrence H. Brent talking about how he diagnosed one of his patients with psoriatic arthritis. To access this and other episodes in our series, visit Living Rheum on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!