PMC2760131_01
Symmetric polyarticular psoriatic arthritis affecting all the proximal interphalangeal joints of the fingers except the left ring finger PIP joint which seems to be protected by wearing a golden ring. Psoriatic nail changes are also evident in this photo.
CRM2009-518976.001.jpg
PMC2760131_01_CRM2009-518976.001.jpg
fig1
On examination, there was synovitis at the proximal interphalangeal (PIP) joints in a symmetrical distribution of all the fingers of both hands except the PIP joint of the left ring finger (Figure 1). There was also prominent nail (Figure 1) and skin changes consistent with psoriasis.
MRI of the proximal interphalangeal joints of both hands confirms sparing of the left ring proximal interphalangeal joint. All other proximal interphalangeal joints show marked synovitis and erosions.
CRM2009-518976.002.jpg
PMC2760131_01_CRM2009-518976.002.jpg
fig2
MRI scan (Figure 2) and ultrasound studies (USs) of the hands confirmed the presence of joint space narrowing and extensive synovitis with articular erosions at the PIPs of all the fingers sparing the left ring finger PIP joint.