Severe mutilating of the fingers caused by Psoriatic Arthritis.

PSORIATIC ARTHRITIS

Psoriatic arthritis/arthropathy (PsA) is a seronegative spondyloarthropathy that is characterized by stiffness, pain, swelling, and tenderness of the joints and surrounding ligaments and tendons.

MSUS (musculoskeletal ultrasound) has become extremely valuable in diagnosing PsA.
It has been estimated that about 30% of patients with psoriasis will/do have psoriatic arthritis.
85-90% of patients with PsA present with psoriasis first.
For those patients overweight with psoriasis but not PsA, losing weight greatly decreases their risk of developing PsA.
Deformities include mutilating arthritis, telescoping of and sausage digits.
Ustekunumab may improve psoriasis but there are reports of it causing or PsA.

Clinical Subtypes

Asymmetrical oligoarticular arthritis. This is the most common. PIP, DIP, knee and hip joints are commonly involved. Sausage fingers may develop.
Distal interphalangeal arthritis. Preferential involvement of the DIP joints occurs. Nail dystrophy is common.
Mutilating psoriatic arthritis. Osteolysis results in severe mutilation of the hands with telescoping of the fingers.
Symmetrical polyarthrtitis. This pattern is reminiscent of rheumatoid arthritis.
Spinal form of psoriatic arthritis. Spinal involvement predominates.
Pustulosis palmoplantaris with osteoarthritis sternoclavicularis including the SAPHO syndrome.
POPP--psoriatic-onycho-pachydermo-periostitis. The joints of the hands and fingers are most frequently involved often with nail damage.

PsA may be mutilating with great loss of function.

Musculoskeltal Ultrasound

MSUS (musculoskeletal ultrasound) has become extremely valuable in diagnosing PsA. Patients with psoriasis being evaluated for a potential early PsA diagnosis should undergo MSUS of the bilateral quadriceps tendon, patellar ligament, Achilles tendon, and plantar fascia entheses at a minimum.

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