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Skill Checkup: A 48-Year-Old Man With Treated Psoriatic Arthritis and Fatigue, Weakness, and Dull Abdominal Pain

Abhishek Nandan, MD

Disclosures

June 18, 2024

A 48-year-old Asian man in the United States presents with fatigue, weakness, and a dull pain in his upper right abdomen at a regular follow-up visit with his rheumatologist. He was diagnosed with psoriatic arthritis at age 30 years and has been taking an IL-17 inhibitor since. Despite having obesity (5 ft 6 in [1.68 m], 198 lb [89.81 kg]; BMI = 32), the patient has experienced a recent 10-lb (4.53 kg) weight loss. He also reports that the fatigue and weakness are significantly interfering with his daily function.

 Clinical examination reveals elevated blood pressure (145/87 mm Hg) and hepatomegaly. The patient is also a smoker who has been trying to quit. He does not drink alcohol. Upon questioning, the patient reported no major changes to his diet or activity levels that could explain the fatigue and weight loss. He is not experiencing any gastrointestinal symptoms, changes to bowel habits, or visible changes to his stools or urine. He reports no chest discomfort or dyspnea on exertion. He also has not experienced any recent trauma or other incident that could explain the pain in his abdomen.

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