Abstract
An 18-year-old male presented to the rheumatology clinic with a history of severe inflammatory back pain (more on left side), and pain and swelling in left shoulder, elbows, right ankle, and in right 3 rd distal inter-phalangeal joint since last three months. He had been treated earlier with NSAIDS and sulfasalazine for seronegative spondlyoarthropathy; but there was no relief for pain or other symptoms. The present physical examination revealed the classical ‘oil drop sign’ and a band of erythema in the nail of the middle finger, indicating the nail changes associated with psoriatic arthritis (Fig 1). He was started on methotrexate and one month of treatment showed significant improvement in disease symptoms. The case vignette signifies the need for conducting nail examination in routine rheumatology practice.
Highlights
An 18-year-old male presented to the rheumatology clinic with a history of severe inflammatory back pain, and pain and swelling in left shoulder, elbows, right ankle, and in right 3rd distal inter-phalangeal joint since last three months
He had been treated earlier with NSAIDS and sulfasalazine for seronegative spondlyoarthropathy; but there was no relief for pain or other symptoms
The present physical examination revealed the classical ‘oil drop sign’ and a band of erythema in the nail of the middle finger, indicating the nail changes associated with psoriatic arthritis (Fig 1)
Summary
An 18-year-old male presented to the rheumatology clinic with a history of severe inflammatory back pain (more on left side), and pain and swelling in left shoulder, elbows, right ankle, and in right 3rd distal inter-phalangeal joint since last three months.
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