We present a case of psoriatic arthritis preceding the appearance of skin manifestation. A 48-year-old man presented to our hospital with pain in the finger, toe, and ankle joints. The erythematous and swollen joints were 3 joints, and the distribution of them is asymmetrical. The antibodies referring rheumatoid arthritis (RA) were negative. Two years had gone from the onset of joints pain until the appearance of the skin lesions, helping of diagnosis of the psoriatic arthritis. Although the diagnosis of psoriatic arthritis is easily made when the skin lesions of psoriasis are present, it is difficult to diagnose when the arthritis precedes the appearance of the skin lesions. It is important to follow up asymmetrical oligoarthritis with negative RF even in the absence of typical skin lesions as the possible diagnosis of psoriatic arthritis.
診断に苦慮した，皮疹に先行した乾癬性関節炎の1 例を経験したので報告する。48歳男性，手指，足指，足首の痛みで受診した。発赤・腫脹を認めた関節は3 個で，非対称性の分布を示し，非対称性の少関節炎のパターンを示していた。リウマチ関連の抗体は全て陰性であった。関節痛の発症から2年の経過を経て，乾癬の皮疹が出現し，診断がついた。乾癬性関節炎は皮疹の症状が出現していれば診断が容易だが，関節炎が皮疹より先行する場合診断が難しい。リウマチ因子が陰性で非対称性の少関節炎を呈する患者を診た場合，初期には皮疹の出現がなくても，乾癬性関節炎の可能性を考え経過をみていくことが重要と考えられる。
A case of psoriatic arthritis preceding the appearance of skin manifestations
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