Psoriatic Arthritis Clinical Case Review

Ethan Craig, MD, Vice Chief of Clinical Affairs at Penn Rheumatology, discusses the results of the case and highlights several key lessons to take from how it progressed.

Editor’s note: The following is an automatically generated transcript of the above video.

"About one month later, he returned, and at this point, his joint pain had completely resolved, despite continuing to taper off his steroids in between visits. He was now off of steroids entirely and had no ongoing swelling of the knee, and this had resolved really within about one to two weeks of that last visit, so about within one or two weeks of starting doxycycline, though it did coincide with about three to four days post the first dose of Cimzia. His psoriasis, at this point, has actually cleared, and so what we're left with is this presumed triple diagnosis of a patient with likely underlying psoriatic arthritis, likely gout, and possible superimposed Lyme arthritis.

So what's the point of this case? Why do we bring this up? Let's just emphasize a couple things. I think this case really drove home the need to avoid anchoring on a single diagnosis. Yes, this was a patient with psoriatic arthritis, but that doesn't stop him from having other conditions superimposed, and the presence of intracellular MSU crystals still should trigger the diagnosis of gout. Similarly, the presence of a Lyme ELISA and the setting of a person with suggestive features of significant knee swelling, oligoarthritis, should at least trigger thought for possible Lyme arthritis. Hickam's dictum, that the patient have as many diagnoses as they please, sometimes applies over Occam's razor in cases like this, and ultimately, I'm thankful the patient is doing well and has improved from his visit. Thanks for your time."