Could my psoriasis be causing joint swelling and stiffness?

Question

Hello doctor,

I have been experiencing thick, red, scaly plaques on my elbows, knees, scalp, and lower back for the past six years.

These lesions are intensely itchy and painful, often cracking and bleeding when dry, and have significantly affected my self-confidence, making me hesitant to wear short sleeves or go swimming due to unwanted attention.

Over the past year, I have also developed joint pain, swelling, and prolonged morning stiffness in my fingers and toes lasting more than an hour. Laboratory evaluation revealed an elevated C-reactive protein (CRP) level of 18 mg/L.

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com

I understand your concern.

Based on the symptoms you have described, there is a possibility that you may be experiencing an underlying autoimmune condition. Morning stiffness that improves with activity, along with joint pain, swelling, and involvement of small joints such as the fingers, toes, and wrists, can be suggestive of inflammatory arthritis.

I would like to know whether you have a significant family history, specifically, if any first-degree relatives have been diagnosed with autoimmune conditions such as rheumatoid arthritis or other chronic illnesses.

The skin rash you described may also be related to the same underlying condition. In some cases, inflammatory arthritis can be associated with skin involvement, including vasculitis.

If this is rheumatoid arthritis, the rash could represent rheumatoid vasculitis, which often presents as dry, cracked, painful, and inflamed skin. However, a definitive diagnosis can only be made after reviewing specific blood investigations and directly assessing the skin lesions.

If you are comfortable, please consider sharing clear images of the rash.

Your CRP (C-reactive protein) level is elevated, indicating inflammation, but it is a nonspecific marker and does not pinpoint the exact cause or location of the inflammation.

To help arrive at a diagnosis, I recommend the following blood tests:

Complete blood count (CBC).
Erythrocyte sedimentation rate (ESR).
Rheumatoid factor (RF).
Antinuclear antibody (ANA) titres.
Anti-CCP antibodies.

Please follow up with the above test reports and images of the skin rash.

In the meantime, to help relieve pain and swelling, I am prescribing the following medications.

You may take Naproxen 250 milligrams twice daily after meals for three days to help reduce pain and swelling, along with Pantoprazole 40 milligrams once daily, 30 minutes before food for three days, to protect your stomach while taking the anti-inflammatory medication.

I hope this information is helpful. Please feel free to follow up if you have any further questions.

Thank you.