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Description
A 51-year-old man was diagnosed with psoriatic arthritis at the age of 18.
For the last 20 years he refused treatment, abandoned any follow-up and was unseen by any health professional. The patient became unable to walk 17 years ago and then went blind 10 years ago.
The patient entered the emergency room prostrated; on examination, he was found cachetic in appearance, with psoriatic skin eruptions and nail changes, axial anquilosis and hands with ‘telescopic fingers’ (figures 1 and 2)
Arthritis mutilans is the most severe and destructive form of psoriatic arthritis, range from 3.7% to 6.7% according to different studies.1 When Digit's articular collapse, it leaves redundant overlying skin in shorter fingers, able of a motion like a telescope—the telescopic finger.
Today, with early diagnosis and easy access to disease modifying antirheumatic drugs, such severe deformities are extremely rare.2
Learning points
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Arthritis mutilans (AM) has been described in association with a wide variety of arthropathies, including rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, systemic sclerosis, Systemic lupus erythematosus and others, being the first two most commonly associated diseases.1 ,2
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AM is characterised by an asymmetric pattern of peripheral joint involvement, with a predilection for the interphalangeal and metacarpophalangeal joints of the hand and small jointes of the feet.1
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Radiographically, AM is characterised by the presence of severe boné and joint resorption and deformities.1
Footnotes
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Competing interests None.
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Patient consent Obtained.
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Provenance and peer review Not commissioned; externally peer reviewed.