Psoriatic arthritis

Case contributed by Dr. Suraindra Rajadurai

Presentation

Chronic pain to hands and fingers. Normal rheumatoid factor and serum uric acid levels.

Patient Data

Age: 65 years
Gender: Female
X-ray

Periarticular osteopenia and bony erosions predominantly in the phalanges and interphalangeal joints. Characteristic enthesopathy and pencil-in-cup deformity can be seen particularly in the right 4th proximal phalanx.

Further sclerosis and degenerative changes are noted between the scaphoid and trapezoid, and the scaphoid and trapezium.

Incidental note is made of carpal coalition between the capitate and hamate bilaterally, a normal variant.

Case Discussion

A case of psoriatic arthritis in a patient with a longstanding background of psoriasis.

Psoriatic arthritis is a seronegative spondyloarthropathy characterised by its association with psoriatic skin changes.

It predominantly affects the DIP joints with the hands being more commonly affected than the feet. While the appearance can be quite characteristic on imaging, it shares many similarities with other inflammatory arthritides and rheumatoid factor and uric acid should be checked to exclude rheumatoid arthritis and gout. 

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Case information

rID: 46270
Case created: 29th Jun 2016
Last edited: 20th Sep 2017
Inclusion in quiz mode: Included
Institution: Austin Health

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