Spondylitic psoriatic arthritis presenting as acute urinary retention.
Psoriatic arthritis is a seronegative arthropathy occurring in the presence of psoriasis. In majority of cases, typical psoriatic skin lesions precede joint disease, making diagnosis of psoriatic arthritis without typical skin lesions, a diagnostic challenge. Nail lesions are commonly seen in patients affected by this condition, making it a useful clue in the diagnosis of psoriatic arthritis. This is a case of a 58-year-old Filipino woman presenting with sudden acute urinary retention and weakness of both lower extremities accompanied with active polyarthritis. Onycholytic nail changes initially thought to be a fungal nail infection led to the diagnosis of psoriatic arthritis involving the spine. The patient was eventually treated with methotrexate and non-steroidal anti-inflammatory drugs leading to full resolution of symptoms. The patient is currently ambulatory and on regular follow-up. This case report highlights the importance of clinical and physical findings particularly the nails that would lead to a diagnosis of psoriatic arthritis.
Department of Medicine-Endocrinology, Philippine General Hospital, Manila, Philippines.
Tom Edward Ngo
TE
Lo
Mary Lareine V
ML
Que
Michael L
ML
Tee
D000208:Acute Disease; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D013166:Spondylitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome; D016055:Urinary Retention / Q000175:diagnosis* / Q000628:therapy
D008727:Methotrexate