Roy looks well.

• No evidence of fever
• Vital signs normal
• Has an obvious swelling of the right wrist and other evidence of synovitis in the right wrist with a spongy feel to the swollen joint
• Skin is warm and slightly dusky over the surface of the right wrist joint
• Joint has a reduced range of motion because of pain
• Other joints are normal except for the ring finger, which is sausage-shaped
• A silvery scale is noticed as part of the papulosquamous eruption on elbows
• A few fingernails are thickened and lifting up from the nail bed
• Nails have pits.
  

A silvery scale is noticed as part of the papulosquamous eruption on Roy’s elbows. There are a few fingernails that are thickened and lifting up from the nail bed. The nails have pits. Patient does not have a gonoccocal rash or urethral discharge.

What is the differential diagnosis? Check all that apply.

next: lab & x-ray tests