Severe psoriatic acroosteolysis in the absence of psoriatic arthropathy

Abstract

DESCRIPTIONThe patient was a 74-year-old gentleman with underlying palmoplantar psoriasis ( fi gure 1 ). He was electively admitted for left below knee amputation for cutaneous squamous cell carcinoma at his left heel with locoregional spread. He was incidentally found to have symmetrical shortening of his fi ngers. On further questioning, we discovered that this had occurred over a period of 5 years. He had no joint pain, symptoms of Raynaud phenomenon or traumatic hand injury. On examination, there was symmetrical shortening of the distal phalanges with loss of nails in most of the digits ( fi gure 2 ). Connective tissue screening was negative for antinuclear antibodies, rheumatoid factor and anti topoisomerase I. Radiograph of the hands showed terminal resorption of the distal phalanges that is, acroosteolysis. There were no erosions of the articular surfaces ( fi gure 3 ). The radiographs of his feet were normal. Acroosteolysis is a recognised radiological fi nding in psoriatic arthropathy; which may precede psoriasis by years. 1 The other wellestablished aetiologies of acroosteolysis are scleroderma, frostbite and hyperparathyroidism. This case highlights the occurrence of psoriatic acroosteolysis in the absence of psoriatic arthropathy. To the best of our knowledge, this is the second reported case of its kind. 2 In 1959, Buckley et al reported a case of psoriasis with progressive osteolysis following trauma. This was thought to be linked to Koebner phenomenon which is known to occur following physical stimuli. 3 This case differs from that as there were no identifi able triggers. Till today, the pathogenesis involved in the osteolytic process remains unknown.

Epithelium-Derived Wnt Ligands Are Essential for Maintenance of Underlying Digit Bone

“…In several skin diseases, including scleroderma and psoriasis, acro-osteolysis of the terminal phalanx is associated with a nail dystrophy phenotype (Sakthiswary et al , 2011), however, it was generally not known how these two conditions were related. In this study, we revealed that the nail epithelium is essential for digit bone maintenance (Fig.…”

Nail changes in acro-osteolysis: A case report and review of the literature

“…The term racquet nail is synonymous but implies associated deformity of the bone and soft tissue 11, 12, 13. Other reports include anonychia, atrophy, transverse ridging, discoloration, thickening of the nail plate, hyperkeratosis of the cuticles, pincer nails pitting, and onycholysis 13, 14, 15, 16, 17, 18, 19, 20. Longitudinal ridging is evident in some published photographs 1 , 2 .…”

A Unique Incidental Finding in Two Young Dancers

“… 7 The differential for acroosteolysis includes systemic conditions such as scleroderma, as well as inflammatory arthritidies such as psoriatic and rheumatoid arthritis. 1 , 3 , 5 , 8 , 12 It can also be associated with vascular, toxic, metabolic, traumatic, and infectious etiologies. 2 , 4 - 6 , 9 It has been described as a component of various rare, genetic syndromes, and can be idiopathic in etiology.…”

“…In cases of psoriatic arthritis, acroosteolysis may be seen preceding the onset of clinical psoriasis or psoriatic arthropathy and may be the first evidence of disease. 12 Findings of osteolysis differ somewhat across these disease processes, much as arthritic symptoms differ in that joint and digit involvement is typically more symmetric in rheumatoid arthritis compared with psoriatic arthritis. 8 …”

“…7,11 Acroosteolysis has also been reported as a radiographic finding in several connective tissue disorders and inflammatory arthritidies. 1,3,5,8,12 As many as one-third of patients with systemic sclerosis may show signs of moderate to severe acroosteolysis on radiography and ultrasonograpy. 1,3 Acroosteolysis is a strong predictor of digital ischemia and disease progression in patients with systemic sclerosis.…”