Case history
Case history #1
A 25-year-old man presents with painful forefeet, a swollen right knee, and a swollen index finger. These symptoms developed over 2 months. He has had a history of psoriasis since age 18 years. Exam reveals psoriatic plaques at the knees and elbows as well as at the posterior hair line and psoriatic nail changes of both fingers and toes. There is a dactylitis of the right index finger and several toes, as well as synovitis of the right knee.
Case history #2
A 57-year-old woman presents complaining of pain and stiffness in both knees and the left foot. Past medical history is notable for severe dandruff and an episode of apparent gout in the left first toe 6 months ago, which never resolved. Exam confirms scalp psoriasis, synovitis of the knees, and a dactylitis of the left first toe.
Other presentations
Approximately 20% of patients may present with an arthritis compatible with psoriatic arthritis (PsA) but without skin disease.[3] Some of these patients have a family history of psoriasis or PsA, or may develop skin disease at a later date. Presentation with axial psoriatic spondylitis without peripheral joint involvement is uncommon.[4]
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