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Psoriatic arthritis — MCCQE Part 1 MCQ

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ModerateJoint PainPsoriatic arthritisMCCQE Part 1

A 42-year-old woman has chronic plaques on her elbows and scalp plus 2 months of swollen painful fingers and morning stiffness. Examination shows nail pitting and dactylitis. Rheumatoid factor is negative. What is the most likely diagnosis?

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Correct answer: A — Psoriatic arthritis

Psoriasis, nail pitting, dactylitis, inflammatory morning stiffness, and seronegativity point to psoriatic arthritis. Osteoarthritis has mechanical pain and bony enlargement rather than dactylitis. Reactive arthritis follows infection and often includes conjunctivitis or urethritis. Fibromyalgia causes widespread pain without objective synovitis or nail changes.

Reference: Canadian Rheumatology Association spondyloarthritis guidance