My patient's bilateral posterior tibial tendinitis, diagnosed a year before the onset of his shoulder pain, was probably such an inflammation. This is especially likely given the bilateral symptoms and the absence of a history of substantial weight bearing or overuse before the onset of the tendinitis, about 2 months prior to the development of skin lesions. Radiographic features of PA are a mixture of bone remodeling and osteolysis. Typical radiographic changes are seen in the interphalangeal joints and the spine. The goals of PA treatment are reduced inflammation and improved range of motion.
Most patients require disease-modifying agents.
An active patient's joint symptoms are commonly from acute injury or overuse. However, this case presents unusual features of both the history and physical examination and demonstrates the need for a broad differential diagnosis followed by appropriate clinical and laboratory investigation. A careful history may bring to light medical conditions a patient considers insignificant, and a thorough physical examination may suggest an underlying medical condition. Physicians must keep an open mind in evaluating any patient so that prompt diagnosis, treatment, and return to an active lifestyle are not delayed. Rheumatology, ed 2.