Pustulotic arthro-osteitis with distal phalanx osteitis.

Area of Science:

• Rheumatology
• Dermatology
• Orthopedic Surgery

Background:

• Palmoplantar pustulosis is a chronic inflammatory skin condition.
• Pustulotic arthro-osteitis (PAO) is a rare complication of palmoplantar pustulosis involving bone and joint inflammation.
• PAO commonly affects the sternoclavicular joints but can also involve peripheral joints and bones.

Purpose of the Study:

• To report a rare case of pustulotic arthro-osteitis presenting with sternoclavicular joint and finger involvement.
• To emphasize the diagnostic value of histopathological examination in cases of finger osteitis associated with PAO.

Main Methods:

• Clinical presentation of a 68-year-old Japanese woman with palmoplantar pustulosis, anterior chest pain, and finger pain.
• Diagnostic imaging including computed tomography (CT), technetium-99m bone scintigraphy, and contrast-enhanced magnetic resonance imaging (MRI).
• Surgical amputation of the affected distal phalanx for histopathological evaluation.

Main Results:

• Imaging revealed sternal bone thickening, sternoclavicular joint and sternal angle involvement, and osteitis of the sternum.
• Histopathological examination of the amputated finger confirmed chronic non-bacterial osteitis, associated with pustulotic arthro-osteitis.
• The patient was diagnosed with pustulotic arthro-osteitis affecting both the axial skeleton and a peripheral digit.

Conclusions:

• Pustulotic arthro-osteitis can manifest with diverse skeletal involvements, including peripheral osteitis.
• Histopathological examination, though rarely performed for finger osteitis in PAO, provides crucial diagnostic confirmation.
• Early and accurate diagnosis is essential for appropriate management of PAO.