Date:
Patient:
Reason for Visit:
Follow-up for psoriatic arthritis (PsA)
Evaluation of disease activity, joint pain, and response to treatment
New symptom evaluation (e.g., morning stiffness, fatigue, functional limitations)
History:
Present Illness:
Onset, duration, and course of psoriatic arthritis
Number of affected joints, location (symmetrical or asymmetrical)
Severity of joint pain, stiffness (morning stiffness duration)
Functional limitations (difficulty with daily activities)
Fatigue level and impact on overall well-being
Past Medical History (PMH):
Psoriasis (plaque location, severity)
Other relevant medical conditions (inflammatory bowel disease, uveitis)
Family History: Family members with psoriasis or PsA
Social History:
Smoking and alcohol use (can worsen PsA)
Stressful life events (may trigger flares)
Medications:
Current medications for PsA (disease-modifying antirheumatic drugs (DMARDs), biologics, pain relievers)
Over-the-counter medications used for pain or inflammation
Physical Exam:
General:
Assess for signs of inflammation (fever, malaise)
Evaluate overall health and functional status
Musculoskeletal:
Evaluate joints for:
Tenderness
Swelling
Warmth
Joint deformity (e.g., sausage digits)
Range of motion limitations
Compare affected joints to unaffected ones for symmetry
Skin:
Look for psoriatic plaques (red, raised, scaly patches)
Diagnostic Tests (may be ordered depending on clinical presentation):
Complete Blood Count (CBC): to rule out infection or inflammatory processes
C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR): inflammatory markers elevated in active PsA
Rheumatoid factor (RF) and anti-citrullinated protein antibody (anti-CCP): usually negative in PsA (helps differentiate from rheumatoid arthritis)
X-rays: to assess for joint damage (erosions)
MRI: may provide more detailed information about joint inflammation and damage
Ultrasound: useful for evaluating soft tissues like tendons and bursae
Assessment:
Psoriatic arthritis disease activity: Consider using PsA-specific scoring systems like PASI (Psoriatic Arthritis Severity Index) or DAPSA (Disease Activity in PsA).
Joint involvement: Number of affected joints, symmetry, and presence of deformities.
Functional limitations: Impact of PsA on daily activities.
Comorbidities: Presence of psoriasis, other inflammatory conditions, or risk factors like obesity.
Treatment response: Evaluate effectiveness of current medications and identify any side effects.
Plan:
Treatment plan based on disease activity, joint involvement, and patient factors:
Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
Disease-modifying antirheumatic drugs (DMARDs) like methotrexate, sulfasalazine, or leflunomide (to slow disease progression and joint damage)
Corticosteroid injections for short-term pain relief in specific joints
Biologic therapies (tumor necrosis factor-alpha inhibitors or interleukin-17 inhibitors) – for moderate to severe PsA or those unresponsive to DMARDs
Physical and occupational therapy to improve joint function, strength, and range of motion
Lifestyle modifications:
Maintain a healthy weight
Smoking cessation
Regular exercise program tailored to individual abilities
Stress management techniques
Referral to a rheumatologist: For complex cases, diagnostic uncertainties, or consideration of biologic therapy.
Patient education: Provide information about PsA, its link to psoriasis, disease course, treatment options, potential side effects, importance of self-care, medication adherence, and healthy lifestyle habits.
Follow-up:
Schedule for regular follow-up appointments to monitor disease activity, adjust treatment plan as needed, address new concerns, and manage potential complications (e.g., osteoporosis).
Discuss the importance of long-term management for PsA, as it is a chronic condition.