Onycho-Pachydermatit with extensive bone marrow edema predominant in the metacarpals: a “forme fruste” of POPP?

It is an uncommon subset of psoriatic arthritis that is characterized by psoriatic onychodystrophy, onycholysis, connective tissue thickening above the distal phalanx as well as specific radiologic changes such as periosteal reaction and bone erosions of the distal phalanges.1 In this article, the case of a 53-year-old male patient with POPP who responded dramatically to methotrexate has been discussed. CASE REPORTA 53-year-old male patient was admitted to the dermatology clinic with nail changes and pain in all the fingers, which started approximately one year prior to admission. His nail biopsies were unremarkable and his condition was unresponsive to anti-fungal medications ordered by several dermatology clinics over the past one year. Thereafter, the patient was referred to our clinic for flexion deformity of the distal interphalangeal (DIP) joints. He had painful swellings with functional impairment in the DIP joints for seven to eight months after which the deformities started to develop. A written informed consent was obtained from the patient.Our patient was working as a documentalist with no history of trauma or repetitive injury. On rheumatologic evaluation, there were no remarkable findings such as recurrent genital aphthous ulcers, oral aphthous ulcers, dry eyes and mouth, back pain, morning stiffness, bowel related symptoms, repeated fever or abdominal pain, and any other dermatologic rash. He had no systemic diseases, history of infection, recent vaccinations, or regular drug use. Family history was negative for psoriasis or other skin diseases. A physical examination revealed erythematous swellings and flexion deformities in all the DIP joints. All the fingernails had severe dystrophic changes. A psoriatic plaque was present on the extensor surface of the right elbow. ABSTRACTWe present a case with psoriatic onychodystrophy, onycholysis, connective tissue thickening above the distal phalanx as well as specific radiologic changes diagnosed as psoriatic onycho-pachydermo-periostitis who responded dramatically to methotrexate with current literature review. In this article, we report a 53-year-old male patient with psoriatic onycho-pachydermo-periostitis who responded dramatically to methotrexate.

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“…9 Sanal et al 10 described a case of POPP with extensive bone marrow edema of the metacarpal bones without distinctive periostitis.…”

Section: Discussionmentioning

confidence: 99%

A Rapidly Progressive Variant of Psoriatic Arthritis: Psoriatic Onycho-Pachydermo-Periostitis

2016

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Onycho-Pachydermatit with extensive bone marrow edema predominant in the metacarpals: a “forme fruste” of POPP?

Cited by 1 publication

References 11 publications

A Rapidly Progressive Variant of Psoriatic Arthritis: Psoriatic Onycho-Pachydermo-Periostitis

A Rapidly Progressive Variant of Psoriatic Arthritis: Psoriatic Onycho-Pachydermo-Periostitis

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