Psoriatic Arthritis

Psoriatic and reactive arthritis ...

Psoriatic and reactive arthritis

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subchondral erosions of the fourth left distal interphalangeal joint and right third and fourth proximal interphalangeal joints with periosteal reaction.

cup-and-pencil deformities of both thumbs and erosion of DIP joint of left middle finger

Anteroposterior radiograph of the feet shows arthritis mutilans. 

Hand film shows swollen 5th digit from psoriatic arthritis.

detail view of 5th finger from same patient shows erosions from psoriatic arthritis.

Psoriatic and reactive arthritis

–Erosive and productive change (also seen in erosive OA)

–Erosions have fuzzy margins and wisps of periostitis

–Distal predominance and soft tissue swelling

–In late phases, ankylosis of joints may occur

–Another feature is sausage digit type soft tissue swelling

–Very late, arthritis mutilans, with resorption of phalanges

–Pencil-in-cup deformity may result

–Bone density usually normal except for juxta-articular osteoporosis

–acroosteolysis is another possible feature

–Although there is overlap, as a general rule, psoriatic favors hands and reactive the foot

Reactive arthritis

–Urethritis (85%)

–Conjunctivitis (60%)

–Arthritis (> 60%)

–Young adults, M:F > 5:1