Presentation
Known to have psoriasis for 40 years, presented with a history of chronic dorsal and lumbar pain.
Patient Data
Age: 75 years
Gender: Male
From the case:
Psoriatic polyarthritis
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The CT images (bone window) demonstrate:
- erosions with irregular destruction and sclerosis of the articular surfaces of the sternoclavicular/manubriosternal joints (arthritis)
- bilateral and extensive facet joints arthritis of the dorsal and lumbar spine
- bilateral and extensive costovertebral/costotransverse arthritis well-visualized on axial and coronal images
- ossification of the interspinous ligaments at the dorsal region
- paravertebral ossification mainly at L4-L5 level, larger and thicker than that seen in ankylosing spondylarthritis.
- irregularity of both sacroiliac joints (sacroiliitis)
From the case:
Psoriatic polyarthritis
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Annotated images:
- red arrows (image A): left paravertebral ossification
- green arrows (image B): manubriosternal arthritis
- yellow arrows (images C, D): sternoclavicular arthritis
- blue arrows (image E): facet joints arthritis
- purple arrows (image F): costovertebral arthritis
- white arrows (image G): sacroiliitis
Case Discussion
The CT features with the involvement of several joints in a patient with psoriasis and negative rheumatoid factor are highly suggestive of psoriatic polyarthritis.
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