|Year : 1997 | Volume
| Issue : 4 | Page : 223-224
Radiological changes in psoriatic arthropathy
RR Mittal, Seema Gupta
R R Mittal
Source of Support: None, Conflict of Interest: None
Forty-one cases of psoriatic arthropathy (PA) were selected for the study. Biopsy, x rays of hands, feet, cervical and dorsolumbar spine, sacro-iliac joints and routine investigations were carried out. Clinical diagnosis of psoriasis was confirmed histopathologically. Radiological changes in order of frequency were most common in feet - 26/41, hands - 24/41, sacro-iliac joints -11/41, dorso-lumbar spine - 4/41 and cervical spine - 3/41. Distinctive radiological changes were seen in psoriatic arthritis.
Keywords: Oligoarthritis, Syndesmophytes, Erosion
|How to cite this article:|
Mittal R R, Gupta S. Radiological changes in psoriatic arthropathy. Indian J Dermatol Venereol Leprol 1997;63:223-4
Psoriatic arthropathy (PA) is defined as an inflammatory disease of joints in patients of psoriasis with negative rheumatoid serology. Bauer in 941 observed that incidence of psoriasis in patients with seronegative polyarthritis was unduly high. Moll and Wright classified PA into 5 broad categories.
- 1. Asymmetrical oligoarthritis of fingers or toes (70%). Associated tenosynovitis produces a classical "sausage" digit.
- 2. Symmetrical polyarthritis simulating rheumatoid arthritis except for absence of RA factor in the blood (15%).
- 3. Classical distal interphalangeal PA (5%).
- 4. Arthritis mutilans (AM)-a severely deforming arthritis with osteolysis, destruction of bones and widespread ankylosis (5%).
- 5. Ankylosing spondylitis with or without peripheral arthropathy (5%).
| Material and Methods|| |
Forty-one patients of PA with negative serology were taken for the study. Detailed history and systemic and dermatological examination were done in all cases. Clinical diagnosis of psoriasis was confirmed by histopathological study. Laboratory investigation included haemoglobin, ESR, serum uric acid, serum globulins and rheumatoid factor. Radiological examination of hands and feet (AP view), cervical acid dorsolumbar spine (AP and lateral view) and sacroiliac joints (AP view) were done in all cases.
| Results|| |
Forty-one cases of PA were studied. Swelling associated with pain of joints was seen in 16 cases i.e. 39%. Radiological changes in order of frequency were most common in feet (63.4%), hands (58.3%), sacro-iliac joints (27%), dorsolumbar spine (9.8%) and cervical spine (7.3%). Changes in hands and feet were tuft resorption in 51.2%, erosion in 46.4%, loss of articular cartilage in 7.2%, widening and new bone formation in 61.1%, mild flexion deformity in 39.1% and ankylosis in 4.8% [Table - 1]. Patients with arthritis mutilans revealed osteolysis, 'pencil in cup' appearance at metacarpo and metatarsophalangeal joints and bony ankylosis with deformity of digits. Radiological changes observed in spine and sacro-iliac joints are given in [Table - 2].
| Discussion|| |
Salient results of the above study were that 34 percent PA were asymptomatic clinically but revealed changes of PA radiologically. Bone changes were most frequent in joints of feet. Most common change was new bone formation at the base of terminal phalanx of great toe. Anterior syndesmophytes were common in cervical spine and paravertebral syndesmophytes in dorsolumbar spine. Articular erosions, juxtaarticular sclerosis and bony ankylosis were seen in sacro-iliac joints. So, detailed x-ray examination in psoriasis can detect early cases of PA and help in their proper management.
| References|| |
|1.||Moll JMH. The clinical spectrum of psoriatic arthritis, Clin Orthopaed 1979;143:66-75. |
|2.||Bauer W, Bennet GA, Zeller JW. Pathology of joint lesions in patients with psoriasis and arthritis, Trans Assoc. Am Phys 1941;56:349-352. |
|3.||Taggart A, Wright V. Psoriatic arthritis, in: Dermatology in General Medicine, 3rd Edn., Editors, Fitzpatrick TB, Eisen AZ, Wolff K, et al, Mc Graw Hill Book Company, New York, 1987;491-499. |
[Table - 1], [Table - 2]