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 patien...

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Bibliographic Details
Published in:BMJ case reports 2014-04, Vol.2014, p.bcr2013202383
Main Authors: Lo, Tom Edward Ngo, Que, Mary Lareine V, Tee, Michael L
Format: Article
Language:English
Subjects:
Acute Disease
Anuria
Arthritis, Psoriatic - diagnosis
Arthritis, Psoriatic - diagnostic imaging
Arthritis, Psoriatic - drug therapy
Asia
Bladder
Diagnosis, Differential
Female
Humans
Knee
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - physiopathology
Methotrexate - therapeutic use
Middle Aged
Other Asian
Patients
Psoriasis
Psoriatic arthritis
Radiography
Risk Assessment
Severity of Illness Index
Skin
Spondylitis - diagnosis
Spondylitis - diagnostic imaging
Spondylitis - drug therapy
Thoracic Vertebrae - diagnostic imaging
Thoracic Vertebrae - physiopathology
Treatment Outcome
Ultrasonic imaging
Unusual Presentation of More Common Disease/Injury
Urinary retention
Urinary Retention - diagnosis
Urinary Retention - therapy
Urinary tract diseases
Urinary tract infections
Urogenital system
Wrist
X-rays
Citations: Items that this one cites
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Summary: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.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-202383