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Psoriatic arthritis — RACP Adult Medicine MCQ

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ModerateRheumatologyPsoriatic arthritisRACP Adult Medicine

A 37-year-old man has heel pain, swollen right knee and a diffusely swollen left index finger. He has nail pitting and scaly plaques on the extensor elbows. Rheumatoid factor is negative. What is the most likely diagnosis?

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Correct answer: D — Psoriatic arthritis

Dactylitis, enthesitis, nail pitting and psoriasis are characteristic of psoriatic arthritis. Rheumatoid arthritis usually causes symmetrical small-joint synovitis without dactylitis. Reactive arthritis, osteoarthritis and CPPD do not explain the psoriasis-nail-enthesis constellation as well.

Reference: Australian Rheumatology Association guidance; Therapeutic Guidelines (eTG)