Case Report
Ashfaq ul Hassan, Farah Sam
Abstract
A fifty year old farmer presented with severe joint pain and swelling in the small joints of hands and feet and a rapidly progressive downhill course over a period of three months. The patient developed joint deformities of hands and feet with digital resorption of the terminal phalanges. Five months after the start of joint deformities, the patient developed well defined erythematosquamous plaques with silvery white scales on the extensor aspect of limbs and scalp. The nails had pitting, discoloration and sub ungual hyperkeratosis. The clinical and histopathological diagnosis was consistent with Psoriasis. A radiograph of hands and feet revealed splaying of the base of the phalanges with tapering of the ends of metacarpals and metatarsals showing ‘pencil-in-a cup’ deformity. Distal inter phalangeal joints were also involved. A diagnosis of Psoriasis with Arthritis Mutilans was made. The patient was put on injectable Methotrexate and oral steroids.