Patient presents with complaints consistent with psoriatic arthritis.  Symptoms include joint pain, stiffness, swelling, and tenderness, particularly affecting the distal interphalangeal joints, as well as enthesitis of the Achilles tendon and plantar fascia.  The patient reports morning stiffness lasting greater than 30 minutes and notes fatigue and reduced range of motion in affected joints.  Examination reveals dactylitis of the second and third toes on the right foot and pitting of the fingernails.  Review of systems reveals a history of plaque psoriasis diagnosed five years prior, currently managed with topical corticosteroids.  Family history is significant for psoriasis in the patient's mother.  Differential diagnosis includes rheumatoid arthritis, osteoarthritis, and reactive arthritis.  Based on the patient's history of psoriasis, characteristic musculoskeletal manifestations, and physical exam findings, a diagnosis of psoriatic arthropathy is made.  Initial treatment plan includes NSAIDs for pain management, referral to physical therapy for range of motion exercises and strengthening, and consideration of DMARD therapy such as methotrexate.  Patient education provided regarding disease progression, medication management, and importance of follow-up care.  ICD-10 code L40.54 (Psoriatic arthropathy) is assigned.  Follow-up scheduled in four weeks to assess treatment response and adjust management as needed.