Review Question - QID 212712

This patient has psoriatic arthritis (e.g., psoriatic lesions with arthritic pain), which has a strong association with HLA-B27.

Psoriatic arthritis is one of the seronegative spondyloarthropathies, which is defined by arthritis without rheumatoid factor (anti-IgG antibody). Seronegative spondyloarthropathies include psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, and reactive arthritis. Patients with psoriatic arthritis present with pain and stiffness with morning stiffness that lasts more than 30 minutes. Physical examination findings include stress pain, joint line tenderness, and effusion in joints in an asymmetric distribution. However, psoriatic arthritis may present with symmetric polyarthritis similar to, and at times indistinguishable from rheumatoid arthritis.

Figure A is a clinical image of skin manifestations of psoriasis characterized by silver scales.

Incorrect Answers:
Answer 1: Bamboo spine, or vertical fusion of the spinal cord, is seen in ankylosing spondylitis. Although this patient is complaining of lower back pain, her skin lesions suggest psoriatic arthritis.

Answer 2: Conjunctivitis can be seen in patients with reactive arthritis, which is characterized by conjunctivitis, urethritis, and arthritis.

Answer 3: Crypt abscesses on colonoscopy are found in patients with inflammatory bowel disease. Patients often complain of abdominal pain and diarrhea; this patient is not presenting with these symptoms.

Answer 5: Rheumatoid factor positivity would not be expected in this patient as psoriatic arthritis is a type of seronegative spondyloarthropathies.

Bullet Summary:
Psoriatic arthritis is associated with skin psoriasis and positive HLA-B27 in patients.