PROBLEM LIST:
1. Psoriatic arthritis characterized by psoriatic skin lesions as well as bilateral wrist pain and inflammation, maintained on methotrexate.
2. Coronary artery disease, status post myocardial infarction with stent MM/DD/YYYY, status post stenting in the fall of YYYY.
SUBJECTIVE: The patient is a very pleasant (XX)-year-old man who returns today for routinely scheduled appointment. He is accompanied today by his wife. He reports that since his last visit on MM/DD/YYYY, he has been doing relatively well with respect to psoriatic arthritis.
His main symptom involves wrist inflammation that really has not been a problem. He did not have morning stiffness. He does have low back pain, usually worse at night. He does not have any flares.
He has been having bilateral shoulder pain as well as right buttock/outer hip pain. These have been chronic issues.
He has had multiple cortisone injections in his shoulders by a physician in XXXX, and he was told that they wanted to remove some bone spurs in his shoulders. He is electing to just continue to manage conservatively and not proceed with surgery.
In terms of his skin, he has a little bit of psoriasis in his scalp but otherwise is fine. He overall feels that if he can maintain his current state of things, he would be very happy.
Current medications include methotrexate 20 mg p.o. q. week, leucovorin 5 mg p.o. q. week, alendronate 70 mg p.o. q. week, calcium with vitamin D, folic acid 2 mg daily, Plavix, Crestor, metoprolol, aspirin, fish oil, lorazepam, zolpidem, and pantoprazole.
OBJECTIVE: Vital Signs: On physical examination, blood pressure 114/64, pulse 52, weight 196 pounds, temperature 97, 98% on room air. Pain is 0 out of 10. General: In no acute distress, alert and oriented x3. HEENT: Sclerae anicteric. No conjunctival irritation. Oral mucosa is moist. No oral ulcers. Neck: Supple. No lymphadenopathy. Lungs: Clear to auscultation bilaterally. Musculoskeletal: The patient had full range of motion of all of his joints with no joint tenderness. He has no subacromial bursal tenderness. He has no greater trochanteric tenderness. He did have tenderness posterior to the greater trochanter on the right side more, in the buttocks area, in the upper outer quadrant.
The patient had methotrexate labs which were all within normal limits. He had a bone density performed today, do not have the results. He had his last bone density in YYYY, showed osteopenia.
ASSESSMENT AND PLAN:
1. Psoriatic arthritis. The patient is doing well. We will continue his current regimen of 20 mg of methotrexate, refill of this, leucovorin, folic acid and Fosamax were all sent to his pharmacy today.
2. History of osteopenia. The patient will continue on Fosamax, calcium with vitamin D. We will let him know what the bone density test shows once we get the report.
3. Return visit in six months.
