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The Role of Sequential Imaging in Psoriatic Arthritis: A Case-Based Review on Identifying Coexisting Microcrystalline
1Department of Rheumatology of Lucania - UOSD of Rheumatology, "Madonna delle Grazie" Hospital, Matera, Italy.
Introduction:
The coexistence of psoriatic arthritis (PsA) and crystal-associated joint disease is an important diagnostic problem in clinical treatment. In patients with established PsA, the presence of new inflammatory responses may indicate disease activity or another pathological state, and thus necessitates differential diagnosis of disease processes and/or a diagnosis of a new disease process.
Presentation:
We report the case of a 55-year-old man with chronic PsA who presented with acute monoarticular inflammation of the left wrist that was refractory to standard antiinflammatory treatment. The discovery of newly observed calcific deposits in the left wrist, observed during sequential plain radiographic evaluation, raised suspicion of a crystal-associated inflammatory process. This discovery provided insight into the treatment regimen and clinical response.
Conclusion:
This case illustrates the need to consider crystal-associated inflammation in patients with PsA who present with atypical or treatment-resistant joint pathology. Sequential imaging, especially plain radiography, might facilitate diagnostic clarification and prevent the inappropriate escalation of immunosuppressive therapy.
