Question

a 52 - year - old female patient presents with skin issues and concomitant joint pain. radiological studies of her hands reveal \pencil - in - cup\ deformity. lab work is positive for hla - b27. which of the following the most likely diagnosis? a) psoriatic arthritis b) reiters syndrome c) rheumatoid arthritis d) ankylosing spondylitis e) osteoarthritis

Explanation:

• Psoriatic arthritis often presents with skin issues (psoriasis) and joint pain. The "pencil - in - cup" deformity is a characteristic radiological finding in psoriatic arthritis. Also, HLA - B27 positivity is associated with psoriatic arthritis.
• Reiter's Syndrome typically has a triad of urethritis, conjunctivitis, and arthritis (though can have skin manifestations like keratoderma blennorrhagicum).
• Rheumatoid Arthritis usually has symmetric polyarthritis, rheumatoid nodules, and positive rheumatoid factor (not typically HLA - B27 positive and no "pencil - in - cup" deformity as a hallmark).
• Ankylosing Spondylitis mainly affects the axial skeleton (sacroiliac joints, spine) with symptoms like inflammatory back pain.
• Osteoarthritis is a degenerative joint disease with no skin manifestations and no HLA - B27 association.

Answer:

A. Psoriatic arthritis