Introduction A seronegative spondyloarthropathy that presents with the following orthopaedic manifestations 5 patterns of arthritis asymmetric oligo/monoarticular arthritis affecting DIPJ, PIPJ, MCPJ DIP-predominant arthritis arthritis mutilans symmetric, RF-negative polyarthritis psoriatic spondyloarthropathy Epidemiology incidence affect up to 5-20% of patients with psoriasis demographics equally affects men and women Genetics HLAB27 found in 50% Presentation Symptoms arthritic symptoms in hands Physical exam rash with silvery plaques over extensor surfaces (elbows, knees) typically precede joint involvement by several years (80-85% of time) hands dactylitis (sausage digit) onychodystrophy (nail pitting) onycholysis (lifting of nail plate starting distally) arthritis mutilans opera glass hands (la main en lorgnette) excess skin from the shortening of the phalanx bones becomes folded transversely, as if retracted into one another like opera glasses chronic uveitis entheses such as achilles tendonitis, posterior tibial tendonitis, and plantar fasciitis Imaging Radiographs hands distal phalanx acrolysis DIP arthritis classic finding is "pencil-in-cup" deformity simultaneous destruction of the head of the middle phalanx and expansion of the base of the distal phalanx different than DJD by presence of centripetal erosions which cause joint space widening small joint erosions or fusions (PIP, MCP, and wrist commonly involved) fluffy periostitis (caused by periosteal ossification) acroosteolysis (resorption of the distal phalanx tuft) flail digits spine in axial disease sacroiliitis syndesmophytes paravertebral ossification destructive discovertebral lesions Studies HLAB27 found in 50% RA and ANA tests are usually negative Treatment Nonoperative NSAIDS, methotrexate, sulfasalazine, cyclosporine,TNF-alpha inhibitors indications mainstay of treatment similar to RA Operative digit fusion vs resection arthroplasty indications advanced joint disease
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.158) A 32-year-old man has a 10-month history of bilateral toe swelling and foot pain. A clinical photo showing his toes is shown in Figure A. On examination of his feet he has tenderness along the posterior tibial tendon bilaterally which worsens with single-leg heel rise maneuvers. Standing radiographs of the feet are normal without deformity of the lesser toes. A clinical photo of his fingernails are shown in Figure B. Which of the following diagnoses is MOST likely? Review Topic QID: 3581 FIGURES: A B 1 Pseudogout (chondrocalcinosis) 3% (79/2789) 2 Gout 3% (93/2789) 3 Psoriatic arthritis 83% (2324/2789) 4 Rheumatoid arthritis 1% (26/2789) 5 Scleroderma (systemic sclerosis) 9% (259/2789) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 (OBQ10.241) A 47-year-old man complains of long standing pain involving the right index, middle, and ring fingers. A clinical image is shown in Figure A. A radiograph is provided in Figure B. Which of the following is the most likely diagnosis? Review Topic QID: 3340 FIGURES: A B 1 Gout 4% (60/1407) 2 Osteoarthritis 2% (23/1407) 3 Rheumatoid arthritis 5% (72/1407) 4 Septic arthritis 0% (2/1407) 5 Psoriatic arthritis 89% (1248/1407) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5