Question
I know a 25 year old woman who has recently complained of pain and swelling of her metacarpophalangeal joints of both her forefingers for the past several months. The right forefinger has a slight lateral twist due to the swelling. She also has a clinical history of being allergic to dust, pollen and strong odours(strong smelling detergent/perfume etc..)For the past three months she has had a nail infarct on her left little finger which seems to be a fungal infection(not confirmed microbiologically). The consultant rheumatologist has suspected poly arthritis and has requested for an ANA immunofluorescence test to be done(results awaited). The subject also has small patches of skin discolouration on her thigh and her left shoulder which have sensation.This discolouration has been there for the past few months.What would the possible diagnosis of this patient be and any suggestions? Thanks in advance.
Answer
The joint symptoms certainly sound inflammatory in nature. The differential diagnosis remains very large but most prominently includes systemic lupus and rheumatoid arthritis. It is hard to comment on the skin lesions without seeing them. I agree with the ANA testing but would also include rheumatoid factor, anti-CCP antibodies, sedimentation rate and C-reactive protein. If the skin lesions persist, a dermatology consultation (and biopsy if deemed appropriate) might be useful.
