The psoriatic great toe or the psoriatic onycho-pachydermo-periostitis of great toe (OP3gt)

Abstract

The onycho-pachydermo-periostitis of the great toe is a characteristic feature of psoriatic arthritis first described by Fournié in 1980. In the affected patients, the great toe involvement is characterised by a relevant osteo-periostitis of the distal phalanx, a thickening of the distal soft tissues associated with a psoriatic onychopathy. In most cases, the distal interphalangeal joint is spared. Radiographic and scintigraphic osteo-periostitis of distal phalanx of the great toe are frequent, being found in about 44% of patients with psoriatic arthritis. However, clinical manifestations, with inflammatory inflammation of the great toe, are rare

Anterior Chest Wall Involvement in Early Stages of Spondyloarthritis: Advanced Diagnostic Tools

“…As in a previous study 4,9 , a bone scan in patients with PsA was found to be sensitive to subclinical lesions. Out of 110 patients with recently diagnosed SpA attending our clinic, 40 subjects (36.4%) qualified for study because they manifested at least 1 symptom (pain or tenderness) in ACW joints.…”

“…More sensitive, although less specific, bone scanning can uncover a general pattern of affected joints, but provides little detailed information on local joint pathology 4,9 . In clinical practice, patients may mention ACW symptoms, but various explanations for them are possible because there are numerous anatomical structures in that area.…”

“…Involvement of anterior chest wall (ACW), in particular of sternocostoclavicular joints (SCCJ), sternocostal joints (SCJ), the manubriosternal joint, and the third inferior medial portion of the sternum, has been reported in patients with spondyloarthritis (SpA) 1,2,3,4 . Bone scanning has been found to be very sensitive in these cases, although its specificity as a diagnostic procedure is considered low 4,5,6,7,8,9 . Conventional radiography is of limited value because uniplanar imaging of ACW joints has low sensitivity to initial pathological alterations 5,6,7,8 .…”

“…Studies have reported a correlation between the frequency of ACW involvement and the course and the severity of SpA 15,16,17,18 , and more recent data suggest that it is often the first symptom of the disease in undifferentiated SpA (uSpA) 4,9,19,20 . Another aim was to study the prevalence of ACW involvement in these patients and to ascertain which joints are most frequently involved, and the frequency of human leukocyte antigen (HLA).…”