Referral for trauma-related injuries

Dear Colleague,

I am writing to refer a patient who presents with polyarthropathy, severe right hand pain, and significant functional impairment, with a clinical suspicion of psoriatic arthritis or rheumatoid arthritis. The patient is scheduled for a specialist evaluation on April 2nd, but requires interim management and further assessment.

The patient reports progressive joint pain and swelling, initially involving multiple joints and now significantly affecting the fourth digit metacarpophalangeal joint of the right hand, as well as the left hand, toe, knee, and back. These symptoms have led to substantial functional limitations, particularly impacting the patient’s ability to perform occupational duties in construction. The patient has been using acetaminophen and nonsteroidal anti-inflammatory agents without relief. There is a history of cutaneous plaques on the chest, which raises the possibility of psoriatic arthritis. The patient denies recent trauma, infection, or other systemic symptoms.

On physical examination, there was tenderness and swelling over the metacarpophalangeal joints, particularly the fourth digit of the right hand, with similar findings on the left hand. The patient also reported pain in the toe, knee, and back. Blood work did not reveal any alarming findings but was inconclusive for a definitive diagnosis.

To address the acute flare of symptoms, the patient was administered a dose of intravenous methylprednisolone and prescribed a short course of oral prednisone to manage inflammation and improve functionality until the specialist evaluation. A work note was also provided to support the patient in maintaining employment during this period.

I kindly request your expertise in further evaluating and managing this patient’s condition. Please do not hesitate to contact me if additional information is required.

Sincerely,

Dr. Jamie Lin  
Regional Medical Center