Psoriatic Spondyloarthropathy

Psoriatic arthropathy usually involves the cervical spine and the upper extremities.

Clinical Presentation

Patients with psoriasis tend to develop erosive arthritis affecting the fingers, especially at the distal interphalangeal joints. Occasionally the arthritis is mutilating and leads to destruction of the interphalangeal joints. Shortened, telescoping fingers lead to "opera glass hand." Arthralgia in large joints and pain due to enthesopathy (heel cord pain, plantar fasciitis) are frequently seen. The disease commonly involves the skin and the nails.

Up to 30% of psoriatic patients develop spondyloarthropathy, especially of the cervical region. Many have unilateral or bilateral sac-roiliitis as well. Not infrequently the spinal changes remain asymptomatic and are discovered only incidentally. This occurs more frequently in males. The spinal changes may be attributed to psoriasis only when cutaneous, nail, or joint changes consistent with the disease develop.

The spinal changes consist of multiple asymmetrical syndesmoph-ytes that fuse adjacent vertebrae. A large region, mostly in the cervical spine, may be totally fused. The vertebral bodies as well as the facet joints may be fused. These changes are best seen on plain X-rays and CT scans and, in some cases, may be indistinguishable from those seen in AS.

Was this article helpful?

0 0

Post a comment