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Arthritis Mutilans: A Devastating Manifestation of Psoriatic Disease Without Dactylitis in a 61-Year-Old Patient

Azalea Guadalupe Altamirano De La Cruz1,2, Francisco Javier Lugo Rincón-Gallardo3, Maria Daniela Salazar López4

  • 1Internal Medicine, Mexican Social Security Institute (IMSS) General Zone Hospital No. 8, Ensenada, MEX.

Cureus
|August 25, 2025
PubMed

Insights

Arthritis mutilans, a severe psoriatic arthritis form, causes digital shortening and disability. Early identification is key to prevent irreversible joint damage and functional loss in at-risk patients.

Area of Science:

  • Rheumatology
  • Dermatology
  • Osteology

Background:

  • Psoriatic arthritis (PsA) encompasses a spectrum of inflammatory conditions.
  • Arthritis mutilans (AM) is the most severe and least common subtype of PsA.
  • AM is characterized by severe osteolysis leading to digital shortening and functional impairment.

Observation:

  • A 61-year-old male with plaque psoriasis and poor treatment adherence presented with AM.
  • The condition affected the interphalangeal joints of the left foot, causing significant deformity.
  • Extensive skin involvement (30% body surface area) and severe bone breakdown were noted on imaging.

Findings:

  • Imaging confirmed severe bone resorption, resulting in "telescoping" of the phalanges.
  • AM commonly involves distal interphalangeal joints and may be associated with dactylitis.
  • While rare, AM can occur in other rheumatic diseases like rheumatoid arthritis and systemic lupus erythematosus.

Implications:

  • Standardized definitions and understanding of AM predictors are currently lacking.
  • Early recognition of patients at risk for AM is crucial.
  • Timely intervention can prevent irreversible joint damage and mitigate profound functional disability.
Keywords:
arthritis mutilansbone resorptiondactylitisjoint destruction psoriasistelescoping fingers

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