Psoriatic Arthritis with Dactylitis

Key Diagnostic Features

The clinical presentation of unilateral palm swelling with heat affecting wrist movement most strongly suggests psoriatic arthritis (PsA) with dactylitis, particularly given the characteristic combination of inflammatory features and functional impairment, as recommended by the American Academy of Dermatology 1
Dactylitis ("sausage digit") is a hallmark manifestation of PsA that presents as inflammation of small joints in the hands with periarticular swelling, as noted by the American Academy of Dermatology 1
Swelling extending along the entire digit into the palm is a characteristic feature of PsA, according to the American Academy of Dermatology 2
Associated warmth and erythema indicating active inflammation are common in PsA, as reported in the Annals of the Rheumatic Diseases 3
Significant functional impairment at adjacent joints, including the wrist, is a key feature of PsA, as observed by the American Academy of Dermatology 2

Psoriasis precedes arthritis in 72.7% of cases, as reported by the American Academy of Dermatology 1
Nail involvement (pitting, onycholysis) is highly suggestive of PsA, according to the American Academy of Dermatology 2
Enthesitis, or inflammation at tendon/ligament insertion sites, should be evaluated in patients with PsA, as recommended by the American Academy of Dermatology 1
Achilles tendon involvement is common in PsA, as noted by the American Academy of Dermatology 2

Clinical assessment should include evaluation for dactylitis across all digits, assessment of inflammatory features, and morning stiffness duration, as recommended by the American Academy of Dermatology 2 and the Annals of the Rheumatic Diseases 3
Rheumatoid factor testing is typically negative in PsA, as reported by the American Academy of Dermatology 2
Plain radiographs of hands and wrists are recommended as initial imaging, according to the Annals of the Rheumatic Diseases 5

Early recognition of PsA is critical because it can cause significant morbidity if inadequately treated, as noted by the American Academy of Dermatology 1
Delay in diagnosis leads to permanent joint destruction, as reported by the American Academy of Dermatology 1
PsA is associated with increased cardiovascular disease and diabetes risk, according to the American Academy of Dermatology 1