Age / Sex : 62 / M

Chief complaint: finger swelling and pain
What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Please submit only one answer)

Courtesy: Hye Won Chung, University of Ulsan College of Medicine, Asan Medical Center

Psoriatic arthropathy

Discussion

Findings:

Rt. Hand AP radiographs (2014-09-01).

Fusiform soft tissue swelling at right 1^st finger.

Joint space narrowing with both marginal and central bone erosion at 1^st IP joint.

Fluffy and speculated change along the radial side of outer cortex at 1^st proximal phalangeal bone, suggesting findings of fluffy periostitis.

Diffuse soft tissue swelling at right 3^rd DIP joints.

Rt. Hand AP radiographs (2015-04-03).

Decreased soft tissue swelling but remnant bone erosion at right 1^st IP joint with papered bone end of proximal phalanx and central erosion at distal phalanx causing “pencil- and-cup” deformity.

Similar erosion at 2^nd and 3^rd DIP joins.

Small marginal bone erosion and soft tissue swelling at 4^th DIP joint.

Differential Diagnosis:

 Other seronegative spondyloarthropathy

 Rheumatoid arthritis, less likely

 Infectious arthritis, less likely