Bone Ache and Stiffness

3. A 45-year-old man with longstanding psoriasis began experiencing finger pain and swelling. The patient, who had a history of hepatitis C, noted that his fingernails had recently begun crumbling and his fingers were stiff in the morning.

Diagnosis: Psoriatic arthritis (with dactylitis and significant distal interphalangeal joint [DIP] involvement) was diagnosed in both hands, but the left hand was worse. The condition of the patient’s nails was not surprising, given that almost all patients with psoriatic arthritis have nail involvement. Radiographs of the patient’s hands showed periarticular erosions and new bone formation. There was also telescoping of the third DIP joint.

For more information, read “Finger pain and swelling.” J Fam Pract. 2015.

Photo courtesy of Ricardo Zuniga-Montes, MD; text courtesy of Richard P. Usatine, MD. The case was adapted with permission from Chumley H, Usatine R. Arthritis overview. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:562-568.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

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