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Measuring Psoriasis Severity at Home
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Psoriasiform disorders with joint symptoms.

Klara Mosterd1, Theodoor H Kapinga, Herm Martens

  • 1Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands. k.mosterd@mumc.nl

Nederlands Tijdschrift Voor Geneeskunde
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PubMed
Summary

A man with painful swollen digits and nail changes was diagnosed with spondyloarthropathy. Despite treatment with doxycycline, methotrexate, and etanercept, his condition showed insufficient response.

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Area of Science:

  • Rheumatology
  • Dermatology
  • Immunology

Background:

  • Spondyloarthropathy is a group of inflammatory diseases affecting the axial skeleton and peripheral joints.
  • Peripheral arthritis can manifest with dactylitis, nail changes, and skin lesions, mimicking other conditions.

Observation:

  • A 49-year-old man presented with a 3-year history of painful, swollen digits and nail keratosis.
  • He also had psoriasiform skin lesions on the soles of his feet and reported dysuria.
  • Physical examination revealed extensive digital swelling.

Findings:

  • Radiographic imaging confirmed arthritis.
  • Rheumatoid factor was negative, but HLA-B27 was positive, strongly suggesting spondyloarthropathy.
  • The patient was diagnosed with either reactive arthritis or psoriatic arthritis.

Implications:

  • This case highlights the diagnostic challenge of peripheral spondyloarthropathy, particularly when presenting with dactylitis and skin manifestations.
  • The patient's insufficient response to initial combination therapy (doxycycline, methotrexate) and subsequent addition of etanercept underscores the complexity of managing this condition.
  • Further investigation into treatment optimization for refractory spondyloarthropathy is warranted.