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Psoriatic spondyloarthritis — SCE Rheumatology MCQ

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HardSpondyloarthropathiesPsoriatic spondyloarthritisSCE Rheumatology

A 46-year-old man with psoriasis has back stiffness, dactylitis and DIP joint pain. Radiographs show asymmetric sacroiliitis, fluffy periostitis and pencil-in-cup change in one finger. RF is negative and CRP is 28 mg/L. What is the most likely diagnosis?

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Correct answer: E — Psoriatic spondyloarthritis

Axial involvement with asymmetric sacroiliitis, dactylitis and pencil-in-cup erosive change is characteristic of psoriatic arthritis with spondyloarthritis features. OA would not explain dactylitis or inflammatory sacroiliitis. Hypertrophic osteoarthropathy affects periosteum differently and would prompt malignancy or lung disease evaluation.

Reference: BSR psoriatic arthritis biologic guideline 2022