Why Clinical Skills are Crucial to Early Psoriatic Arthritis Diagnosis

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This is ReachMD, and you’re listening to Beyond Skin Deep: Impacts of Psoriatic Arthritis, sponsored by Lilly.

On this episode titled, Why Clinical Skills are Crucial to Early Psoriatic Arthritis Diagnosis, we will hear from Dr. Joseph Huffstutter, Assistant Clinical Professor at the University of Tennessee College of Medicine at Chattanooga.

Dr. Huffstutter:
This is a different kind of arthritis because you can’t depend as much on your lab as you can for other things so that you have to depend on your clinical skills, and it really is important to take the time for these patients.  These are patients that are not complainers in my practice, and so you really need to spend a little extra time and understand what it’s like to walk in their shoes. 

I think the rules for diagnosing arthritis, especially psoriatic arthritis, are identical to anything you do in medicine—it is a very careful history and physical exam.  In terms of the history, I always tell medical students or residents that rotate through that if you listen to the patients, they’ll tell you what’s wrong with them, so it’s important to understand exactly when their symptoms began and to characterize those symptoms as much as possible.  When we’re dealing with inflammatory arthritic problems and morning stiffness is characteristic, many patients will confuse this.  They’ll think about, well, if they sit down for lunch, they’ll get stiff again, and they’ll say, “Well, I’m stiff all day,” and the way to phrase that question would be, “When you first get up in the morning, how long did it take before you are as limber as you’re going to get?”  And that really kind of clarifies that, and you’re looking for an answer of 30 minutes or greater.  Another way to ask that is, “When is your best time?  Do you feel good in the morning or the afternoon?”  Inflammatory arthritis patients feel better in the afternoon.  Patients with mechanical arthritis feel worse in the afternoon.  Also, trying to understand exactly which joints are involved because the joint pattern can really lead you to the correct diagnosis.  I think the greatest thing to help with this is time, and unfortunately, with all the constraints that we have today, that’s at a premium, so when you’re seeing patients, I think it’s important to block out distractions and really focus on that patient in front of you.  After you get a good history, then it’s important to do a detailed physical exam.  And for new patients in our office, we always have patients put on a gown because that’s the time we really want to get a good exam of not only their joints but their skin and a complete physical exam. 

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