|Title : Case 664|
Age / Sex : 28 / F
Chief complaint :
Erythematous painful swelling on Lt. 4th finger, scaly silvery erythematous plaque on whole body
HAND PA and oblique radiograph shows soft tissue swelling, lack of osteoporosis, joint space narrowing, bony erosion, adjacent irregular bony proliferation and periostitis at 4th DIP joint of left hand.
Other seronegative spondyloarthropathies (AS, reactive arthritis)
Psoriatic arthritis is an inflammatory arthritis that occurs in 10 to 15% of people with psoriasis. Although arthritis can coincide or antedate skin disease, the characteristic rash commonly precedes joint disease by months or years. Histocompatibility typing in patients with psoriatic arthritis has revealed a 25 to 60% incidence of HLA-B27 antigen.
Psoriatic arthritis can affect synovial and cartilaginous joints and sites of tendon and ligament attachment to bone in both the appendicular and the axial skeleton. The most typical sites of abnormality are the interphalangeal joints of the hands and foot, MCP and MTP joint, calcaneus, sacroiliac joint, and spine.
The characteristics radiographic findings of psoriatic arthritis are:
. Bony erosion: “mouse–ear” (marginal bone erosions with adjacent irregular bone proliferation), "pencil-in-cup" deformities (protrusion of a blunted and distorted osseous surface into an adjacent expanded one)
. Joint subluxation or interphalangeal ankylosis
. Arthritis mutilans
. Ivory phalanx involving the distal phalanx of the great toe
. Sacroiliitis: often asymmetrical
. Spondylitis: asymmetric paravertebral ossifications and relative sparing of the facet joints
Resnick, Bone and Joint Imaging, 3rd edition.
Jacobson JA, Girish G, Jiang Y, Resnick D. Radiographic evaluation of arthritis: inflammatory conditions. Radiology. 2008 Aug;248(2):378-89.
Klecker RJ, Weissman BN. Imaging features of psoriatic arthritis and Reiter’s syndrome. Semin Musculoskelet Radiol. 2003 Jun;7(2):115-26.
|Total applicants||32||Correct answers||31|
|윤유성||순천향대 부천병원, 전문의|
|김형민||연세의대 강남세브란스병원, 전문의|
|Total applicants||32||Semi-Correct answers||1|