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Medicine

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Rheumatology

Question
18 out of 20
 

A 35 - year old male develops involvements of PIP, DIP and metacarpophalangeal joints with sparing of wrist and carpometacarpal joints. The probable diagnosis is: (AIPG 07)



A Psoriatic arthropathy
B Osteo arthritis

C Rheumatoid arthritis
D Pseudo gout

Ans. A Psoriatic arthropathy

Definition-It is a seronegative inflammatory arthritis and associated with characteristic changes in the nails (pitting and transverse ridges).

Clinical Features

I. Asymmetrical oligoarthritis (70%) (DIP involvement is a characteristic feature). (FAQ)

II. Sacroiliitis/spondylitis (40%)

III. Symmetrical seronegative arthritis (15%)

IV. Distal interphalangeal joint arthritis (15%)

V. Arthritis mutilans. (AIPG 2005) On X-ray pencil in cup appearance is seen.

Hand Joints involved in Psoriases = PIP + DIP + MCP + Wrist

Extra Edge– Articular Features

1. Scaly skin lesions are seen over extensor surfaces (scalp, natal cleft and umbilicus)

2. The nail changes are pitting, onycholysis, sub – ungual hyperkeratosis and horizontal ridging.

Treatment

1. Analgesics (NSAIDs)

2. Sulphasalazine and gold are used in persistent symptomatic cases without exacerbation

3. Chloroquine and hydroxychloroquine are used

4. Retinoid etretinate 30mg/day is effective for both arthritis and skin lesions

5. Photochemotherapy with methoxypsoralen and long wave ultra violet light (PUVA) are used for severe skin lesions

6. Methotrexate can also given.

Rheumatology Flashcard List

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