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An intractable case of suspected psoriatic arthritis combined with Dupuytren's disease.

Ding WQ, Gu JH - Pak J Med Sci (2015 Jan-Feb)

Bottom Line: Because of the atypical clinical manifestation, the diagnosis perplexed doctors for decades.Without formal treatment, the disease followed a natural course over time.After surgery, contractures of palmar and plantar fascia as well the thumb web were released, and the hallux valgus was corrected.

View Article: PubMed Central - PubMed

Affiliation: Wen Quan Ding, MD, Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.

ABSTRACT
Some cases of psoriatic arthritis (PsA) cannot be explicitly diagnosed, especially when the skin and nail lesions present years after the joint disease or are absent. Autoimmunity may also play a role in the development of Dupuytren's disease. However, the simultaneous presence of PsA and Dupuytren's disease is very rare. We present a patient displaying arthritis in multiple small joints, with bone erosions and bony fusions in all four extremities, combined with Dupuytren's disease. Because of the atypical clinical manifestation, the diagnosis perplexed doctors for decades. Without formal treatment, the disease followed a natural course over time. Reviewing the patient's data, a potential diagnosis of PsA, combined with Dupuytren's disease, was eventually made. After surgery, contractures of palmar and plantar fascia as well the thumb web were released, and the hallux valgus was corrected.

No MeSH data available.


Related in: MedlinePlus

a and b: Radiographs obtained in 1992 showed arthritis in multiple small joints, with bone erosion, in both hands and feet.
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Figure 2: a and b: Radiographs obtained in 1992 showed arthritis in multiple small joints, with bone erosion, in both hands and feet.

Mentions: A 48-year-old female presented with arthritis in multiple small joints, bone erosions and fusions in both hands and feet, Dupuytren's disease in both hands, contracture of the first web spaces in both hands, contracture of the plantar fascia in both feet, valgus of the first to third metatarsophalangeal joints of her left foot, and flexor tenosynovitis of her left thumb. She had a history of progressive hand and foot deformities that began in 1992 as redness and mild pruritus of her right little finger. At the time, conventional radiography showed arthritis in multiple small joints, with evidence of bone erosions in both hands and feet (Fig. 2 a b). Immunological tests were weakly positive or negative for rheumatoid factor (RF, weakly positive twice in 1993 and negative thereafter). She also tested negative for antistreptolysin O (ASO), and had a normal erythrocyte sedimentation rate (ESR) and normal levels of C-reactive protein (CRP), uric acid (UA), antinuclear antibody (ANA), extractable nuclear antigen (ENA), and immunoglobulin (Ig)G, IgA, and IgM. She was treated with a short course of corticosteroids and immunosuppressive agents, but as her diagnosis was unclear and the treatment was ineffective, she discontinued the therapy. Her only experience with suspicious skin lesions occurred 4 years later in 1996, when skin lesions manifested on the sides of both arms, without the presence of a silver scale. The skin lesion lasted for several months. At the time, her dermatologist did not believe that she met the criteria for a diagnosis of psoriasis. She reported that she had not experienced severe hand pain over the intervening years, which allowed her working in a garment factory. The patient denied a personal or family history of psoriasis or other autoimmune disease.


An intractable case of suspected psoriatic arthritis combined with Dupuytren's disease.

Ding WQ, Gu JH - Pak J Med Sci (2015 Jan-Feb)

a and b: Radiographs obtained in 1992 showed arthritis in multiple small joints, with bone erosion, in both hands and feet.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4386194&req=5

Figure 2: a and b: Radiographs obtained in 1992 showed arthritis in multiple small joints, with bone erosion, in both hands and feet.
Mentions: A 48-year-old female presented with arthritis in multiple small joints, bone erosions and fusions in both hands and feet, Dupuytren's disease in both hands, contracture of the first web spaces in both hands, contracture of the plantar fascia in both feet, valgus of the first to third metatarsophalangeal joints of her left foot, and flexor tenosynovitis of her left thumb. She had a history of progressive hand and foot deformities that began in 1992 as redness and mild pruritus of her right little finger. At the time, conventional radiography showed arthritis in multiple small joints, with evidence of bone erosions in both hands and feet (Fig. 2 a b). Immunological tests were weakly positive or negative for rheumatoid factor (RF, weakly positive twice in 1993 and negative thereafter). She also tested negative for antistreptolysin O (ASO), and had a normal erythrocyte sedimentation rate (ESR) and normal levels of C-reactive protein (CRP), uric acid (UA), antinuclear antibody (ANA), extractable nuclear antigen (ENA), and immunoglobulin (Ig)G, IgA, and IgM. She was treated with a short course of corticosteroids and immunosuppressive agents, but as her diagnosis was unclear and the treatment was ineffective, she discontinued the therapy. Her only experience with suspicious skin lesions occurred 4 years later in 1996, when skin lesions manifested on the sides of both arms, without the presence of a silver scale. The skin lesion lasted for several months. At the time, her dermatologist did not believe that she met the criteria for a diagnosis of psoriasis. She reported that she had not experienced severe hand pain over the intervening years, which allowed her working in a garment factory. The patient denied a personal or family history of psoriasis or other autoimmune disease.

Bottom Line: Because of the atypical clinical manifestation, the diagnosis perplexed doctors for decades.Without formal treatment, the disease followed a natural course over time.After surgery, contractures of palmar and plantar fascia as well the thumb web were released, and the hallux valgus was corrected.

View Article: PubMed Central - PubMed

Affiliation: Wen Quan Ding, MD, Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.

ABSTRACT
Some cases of psoriatic arthritis (PsA) cannot be explicitly diagnosed, especially when the skin and nail lesions present years after the joint disease or are absent. Autoimmunity may also play a role in the development of Dupuytren's disease. However, the simultaneous presence of PsA and Dupuytren's disease is very rare. We present a patient displaying arthritis in multiple small joints, with bone erosions and bony fusions in all four extremities, combined with Dupuytren's disease. Because of the atypical clinical manifestation, the diagnosis perplexed doctors for decades. Without formal treatment, the disease followed a natural course over time. Reviewing the patient's data, a potential diagnosis of PsA, combined with Dupuytren's disease, was eventually made. After surgery, contractures of palmar and plantar fascia as well the thumb web were released, and the hallux valgus was corrected.

No MeSH data available.


Related in: MedlinePlus