History and Presentation Adam is a 54-year-old man who presents for a routine checkup, complaining about increasing flares of his psoriasis. He has a 15-year history of mild/occasionally moderate psoriasis and applies topical cream inconsistently. You remind Adam that psoriasis puts him at risk for comorbidities. You check his blood pressure (BP) and order appropriate laboratory tests. Physical findings
• Height: 5 ft 8 in
• Weight: 192 lb
• Body mass index (BMI): 29.0 kg/m2
• BP (treated): 131/86 mm Hg
Laboratory findings
• Glycated hemoglobin (A1C): 6.3%
• Fasting plasma glucose: 121 mg/dL
• Lipids (treated) (mg/dL): total cholesterol (TC) = 215; low-density lipoprotein cholesterol (LDL-C) = 128; high-density lipoprotein cholesterol (HDL-C) = 52
On thorough visual examination, Adam's body surface area (BSA) is >5%. It is evident that Adam's psoriasis has not been well-controlled on his current topical therapy regimen.
As you take out your prescription pad, Adam mentions that he has been waking up most mornings with wrist stiffness and swelling and pain in his ankles. He also complains of fatigue. To assess his complaints, you examine his wrists and ankles and order x-rays, suspecting that
Adam has Psoriatic arthritis (PsA).
You assess Adam's current and future clinical care, considering his increasing difficulties with psoriasis.
Questions
1. Design a comprehensive and holistic recognition and planning for the disorder.
2. Address how the patient's Sociocultural Background can potentially impact optimal management and outcomes.
3. Demonstrate an evidence-based approach to address key issues identified in the case study (See above requirements for references).
4. Formulate a comprehensive but tailored approach to disorder management.