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Inflammatory arthritis in a patient with psoriatic skin lesions suggests psoriatic arthritis.
❑ erosion of terminal phalangeal tufts ❑ “whittling” of the distal end of the terminal phalanges ❑ “pencil-in-cup” deformity of the distal interphalangeal joints
❑ relative absence of osteoporosis ❑ sacroiliitis
❑ atypical spondylitis with syndesmophyte formation. Hyperostosis and paravertebral ossification result, which may lead to vertebral fusion.
Blood studies indicate negative rheumatoid factor and elevated erythrocyte sedimentation rate and uric acid levels.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Joint fluid analysis shows gross pus or watery, cloudy fluid of decreased viscosity, usually with 50,000/µl or more white cells, primarily neutrophils. Synovial fluid glucose is usually more than 40 mg/dl. (See Other types of arthritis, page 584.)
Other diagnostic measures include the following:
❑ X-rays can show typical changes as early as 1 week after initial infection — distention of joint capsules, for example, followed by narrowing of joint space (indicating cartilage damage) and erosions of bone (joint destruction).
❑ White blood cell count may be elevated, with many polymorphonuclear cells; erythrocyte sedimentation rate is increased.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Inflammatory arthritis in a patient with psoriatic skin lesions suggests psoriatic arthritis. X-rays confirm joint involvement and show:
❑ marginal erosion at interphalangeal joints with areas of thin, “fluffy” new bone formation
❑ “whittling” of the distal end of the terminal phalanges
❑ “pencil-in-cup” deformity of the distal interphalangeal joints
❑ relative absence of osteoporosis
❑ sacroiliitis
❑ atypical spondylitis with syndesmophyte formation, resulting in hyperostosis and paravertebral ossification, which may lead to vertebral fusion.
Blood studies indicate negative rheumatoid factor and elevated erythrocyte sedimentation rate and uric acid levels.
Source: Handbook of Diseases, 2003
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