TITLE:
A Case of Occult Psoriatic Arthritis: Diagnosis and Management
AUTHORS:
Kamel El-Reshaid, Shaima Al-Bader, Abdulla Al-Refaee
KEYWORDS:
Arthritis, Cyclosporine A, Dermatoscopy, Psoriasis, Therapy
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.15 No.11,
November
9,
2026
ABSTRACT: Background: Acute arthritis (Case: A 32-year-old white male presented with severe arthritis in the 2nd to 5th toes in both feet for 2 weeks. He had a negative history and physical examination, as well as laboratory and immunological tests for autoimmune diseases, gout, and infections. On examination, he had enthesitis and dactylitis. Diagnosis was suspected by typical nail findings of P and confirmed by detecting occult scalp lesions that was confirmed by dermatoscopy. Other etiologies of arthritis were excluded by laboratory, serological, bacteriological, and radiological tests. His arthritis and skin lesions improved within 2 weeks after treatment with Cyclosporine A (CsA) 100 mg twice daily. After 3 months, the CsA dose was reduced to 50 mg twice daily and was maintained for 2 years. Subsequent to this therapy, new skin lesions did not evolve, and arthritis did not recur after 2 more years of follow-up. Conclusion: Occult P can manifest as arthropathy. Nail changes and small skin/scalp lesions may aid in diagnosis, and the disease is amenable to CsA therapy.