Psoriatic polyarthritis

Case contributed by Dr Ammar Haouimi

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
CT

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)
Annotated image

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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Case information

rID: 79439
Published: 30th Jun 2020
Last edited: 1st Jul 2020
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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