PMC8721678_01
Swelling of proximal interphalangeal and distal interphalangeal joints, consistent with psoriatic arthritis.
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Physical examination revealed tenderness and swelling in the bilateral wrists, proximal interphalangeal joints, distal interphalangeal joints, and ankles (Figure 1).
Roughening and cracking of skin on tips and sides of fingers, consistent with mechanic's hands.
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At this facility, DM became a more likely diagnosis due to mechanic's hands finding appreciated by the outside rheumatologist (Figure 2). Although the diagnosis of DM is confirmed by muscle biopsy, this facility deemed it unnecessary to perform a biopsy and decided to proceed with treatment.