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Psoriatic Arthritis
Major points
- Almost always accompanies skin disease, especially nail changes
- Mostly involves DIP
joints of hands > feet
- Classical deformity is
called “cup-and-pencil deformity”
- Erosion of one end of
bone with expansion of the base of the contiguous metacarpal
Psoriatic Arthritis. Radiograph of both hands demonstrates
cup-and-pencil deformities of
both thumbs and erosion of DIP joint of left middle finger
- There is often resorption of terminal phalanges
- There is usually no
osteoporosis
- Most are HLA-B27 positive, RA factor negative
- Characteristic findings
- Tends to involve smaller joints of hand and
foot more than larger joints
- Asymmetrical joint involvement
- Affects both the juxta-articular and articular
margins of joint
Seronegative
Spondyloarthropathies |
Ankylosing
spondylitis |
Psoriatic
arthritis |
Reiter’s syndrome |
- As with ankylosing
spondylitis and Reiter’s syndrome, bone proliferation is a
major feature. Manifests itself with:
- Bony excrescences
- Periosteal new bone formation (common)
- Entire phalanx may become “cloaked” in new
bone
- “Ivory phalanx”
- Most frequent in terminal phalanges of
toes, especially first
- Ankylosis is common
- Especially in PIP and DIP joints of hands
and feet
- Feature common to seronegative
spondyloarthropathies
- Whiskering at sites of tendinous insertion
(enthesopathy) occurs
- Soft tissue swelling of an entire digit (sausage
digit)
- Destruction of IP joint of great toes with
exuberant callous formation is characteristic
- Resorption of tufts of terminal phalanges is
characteristic
- Spine
- Asymmetric paravertebral ossification
- Usually thicker and larger than
syndesmophytes of ankylosing
spondylitis or inflammatory bowel disease
- Occasionally, there are incomplete
non-marginal syndesmophytes similar to AS
- Bilateral sacroiliitis is most common
- May produce erosions and sclerosis
- May produce widening of the SI joints
- SI joint involvement occurs in about 10-25% of
patients with moderate to severe psoriasis
Patterns of Psoriatic Arthritic Changes |
Arthritis involving multiple joints with DIP joint involvement |
Arthritis resembling Rheumatoid Arthritis |
Sacroiliitis and spondylitis |
Arthritis mutilans |
Resnick, 4th Edition
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