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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
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
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
Radiographically, AM is characterised by the presence of severe boné and joint resorption and deformities.1
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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