“ About 20% of those with psoriasis develop psoriatic arthropathy; the onset of arthritis often precedes the skin rash. Types of psoriatic...
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About 20% of those with psoriasis develop psoriatic arthropathy; the onset of arthritis often precedes the skin rash. Types of psoriatic arthritis include true psoriatic, rheumatoid-like, concomitant rheumatoid and psoriatic type. The overall distribution is variable and asymmetrical.
• Interphalangeal joints typically involved
• Marginal erosions, which may progress to a ‘pencil in cup’ deformity
• Soft tissue swelling, ‘sausage digit’
• Resorption of the terminal phalangeal tufts (acro-osteolysis)
• Ivory phalynx
• Periosteal reaction (periostitis)
SPINE X-RAY
• Squaring of the vertebrae
• Atlantoaxial subluxation
• Joint space loss and ankylosis
• Preservation of bone density and new bone formation
• Enthesopathy (e.g. parasyndesmophytes—asymmetrical/unilateral paravertebral ossification with sparing of the annulus fibrosus)
MRI
• Bone marrow oedema can involve the whole vertebral body—distinguishing feature.
• Bilateral sacroiliitis in up to 40%.
Psoriatic arthritis. Right hand x-ray demonstrating marginal erosions affecting the interphalangeal joints, with a ‘pencil in a cup’ deformity (white arrow), and preservation of bone density.
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