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Psoriatic arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesPsoriatic arthritisSCE Rheumatology

A 42-year-old man with psoriasis has swollen right third finger, heel pain and asymmetric knee synovitis. Nails show pitting and onycholysis, RF and anti-CCP are negative, and radiographs show juxta-articular new bone formation with early erosions. What is the most likely diagnosis?

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Correct answer: D — Psoriatic arthritis

Dactylitis, enthesitis, nail disease and asymmetric oligoarthritis with new bone formation point to psoriatic arthritis. Seronegative RA can mimic it but dactylitis and nail disease are discriminating clues. Gout can cause erosions, but the pattern and accompanying psoriasis favour PsA.

Reference: BSR psoriatic arthritis biologic guideline 2022; NICE psoriasis guidance