Juvenile psoriatic arthritis with rash on the hands and knees: diagnostic dilemma

Ohnishi, Takuma; Sato, Satoshi; Tamaki, Zenshiro; Uejima, Yoji; Suganuma, Eisuke

doi:10.1007/s10067-021-05624-8

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…The lack of skin lesions is not rare in the initial presentation of PsA and should be taught to primary care physicians, and collaboration between primary care physicians and rheumatologists should be enhanced [ 24 ]. The dissociation between skin and joint symptoms in some patients with PsA poses a diagnostic dilemma [ 25 ]. As highlighted, while most patients with PsA present with psoriasis before arthritis manifestation, a significant proportion may first display joint symptoms [ 17 ].…”

Section: Reviewmentioning

confidence: 99%

Challenges in Diagnosing Psoriatic Arthritis in Primary Care: A Meta-Ethnographic Study

Ohta,

Sano

2023

Cureus

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Psoriatic arthritis (PsA) is a complex and debilitating chronic inflammatory joint disorder that is often associated with psoriasis and presents significant challenges in its early diagnosis and management. Therefore, this study aimed to investigate the diagnostic intricacies of PsA in primary care settings to shed light on the prevalence, barriers, and implications of delayed diagnosis. To achieve our research objectives, we conducted a qualitative synthesis using the meta-ethnographic method, which is a robust approach for synthesizing qualitative data. We systematically searched the PubMed, Web of Science, and Embase databases for relevant articles using predefined search terms such as "psoriatic arthritis," "diagnosis," and "primary care." The inclusion criteria were narrative articles in English that provided insights into the diagnostic challenges of PsA in primary care. Conference presentations, original articles, and duplicate articles were excluded. Our analysis revealed four key themes that elucidated the multifaceted nature of PsA diagnosis in primary care: (1) a variety of initial and non-specific symptoms, highlighting the diverse clinical presentations that can mimic other conditions; (2) the lack of experience with PsA among primary care professionals, underscoring the importance of education and training; (3) the lack of skin lesions, which can complicate diagnosis when not present; and (4) a delay in diagnosis, with potentially severe consequences for patients' health and quality of life. This study highlights the challenges inherent in the diagnosis of PsA in primary care settings. The multifaceted nature of the disease, coupled with limited experience among primary care providers, often results in delayed diagnosis and subsequent treatment initiation. Early recognition and intervention are pivotal for optimizing patient outcomes. Addressing these challenges necessitates a comprehensive approach involving heightened clinical suspicion, continuous medical education, interdisciplinary collaboration, and utilization of standardized diagnostic criteria. Collaboration between primary care physicians and specialists is crucial for enhancing the accuracy and timeliness of PsA diagnosis and ultimately improving patient well-being and quality of life.

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Section: Reviewmentioning

confidence: 99%

Challenges in Diagnosing Psoriatic Arthritis in Primary Care: A Meta-Ethnographic Study

Ohta,

Sano

2023

Cureus

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“…However, young patients with bilateral uveitis should be evaluated for other possible systemic associations, such as sarcoidosis and TINU syndrome. As highlighted in our case, a cutaneous biopsy may help establish a tissue diagnosis for patients with uveitis, particularly those with skin manifestations [31,32].…”

Section: Case Reports In Ophthalmological Medicinementioning

confidence: 99%

Bilateral Granulomatous Iridocyclitis Associated with Early-Onset Juvenile Psoriatic Arthritis

Nieves-Ríos

Figueroa

Rodríguez

et al. 2022

Case Reports in Ophthalmological Medicine

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Purpose. The purpose of this study is to report on a case of bilateral granulomatous iridocyclitis in a patient with early-onset juvenile psoriatic arthritis (JPsA). Methods. The method used is an observational case report. Observations. A 3-year-old Hispanic girl was sent to our uveitis service for further evaluation of her granulomatous uveitis. The initial ophthalmologic examination revealed bilateral band keratopathy, large mutton-fat keratic precipitates, multiple posterior synechiae, and 4+ anterior chamber cells. The physical exam was notable for left knee edema and right axillary rash. Laboratory testing was remarkable for an erythrocyte sedimentation rate of 80 mm/h, positive antinuclear antibodies (1 : 1, 280), and negative human leukocyte antigen B27. A cutaneous biopsy was obtained, which confirmed the diagnosis of a psoriatic rash. Treatment with oral prednisolone and topical prednisolone acetate with atropine sulfate resulted in the complete resolution of the uveitis. Conclusion and Importance. Bilateral granulomatous iridocyclitis may be a rare presentation of ocular involvement in patients with early-onset JPsA.

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Juvenile psoriatic arthritis with rash on the hands and knees: diagnostic dilemma

Cited by 2 publications

References 5 publications

Challenges in Diagnosing Psoriatic Arthritis in Primary Care: A Meta-Ethnographic Study

Challenges in Diagnosing Psoriatic Arthritis in Primary Care: A Meta-Ethnographic Study

Bilateral Granulomatous Iridocyclitis Associated with Early-Onset Juvenile Psoriatic Arthritis

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