What’s wrong with the hands

What’s wrong with the hands
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(Jeremy Von Grueninsel) #1

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Mr Sore Hands présentes with difficulty using his hands. You did a 4/7 rheumatoid hand examination and really want to save yourself in the discussion. Then the examiners told you this is a recent X-ray of his hands. What is the most likely diagnosis?


(Paul Lin) #2

As Jun and Hao pointed out, this is likely Psoriatic arthritis mutilans (destructive form of PsA) marked by Ankylosis of the right wrist, and “pencil-in-cup” changes in metacarpophalangeal joints which are typical for PsA.

Pencil in cup results from periarticular erosions and bone resorption giving the appearance of a pencil in a cup. Classically seen in PsA but can also be seen in systemic sclerosis, rheumatoid arthritis or reactive arthritis.

So could this also be SS or RA?


https://radiopaedia.org/articles/pencil-in-cup-deformity-1


(Jeremy Von Grueninsel) #3

So if we look at the radiograph here, we can see that the DIPs also have erosions. Therefore it is not rheumatoid arthritis as RhA never involve the DIPs.