Skill Checkup: A 48-Year-Old Man With Treated Psoriasis Has Worsening Tenderness and Stiffness in His Foot and Finger Pain

Marina Magrey, MD


March 20, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 48-year-old man in the United States presents with worsening tenderness and stiffness in his left foot, along with new-onset pain, tenderness, and stiffness in his right index finger. It is hard for him to open jars and zip his jacket, neither of which had been a problem before, and walking can be uncomfortable, especially first thing in the morning. He has had psoriasis for 6 years, which has been managed topically and which does not really bother him, although it is still mildly visible on the scalp and elbows. You notice some slight swelling at the distal interphalangeal (DIP) joints of two left toes and both the proximal interphalangeal (PIP) joint and DIP joint of his right index finger, as well as onycholysis in the same finger. His father had psoriatic arthritis. His height is 5 ft 11 in (180 m), and his weight is 172 lb (78.02 kg).


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