MISCELLANEOUS |
10.5005/IJPMR-30-1-22 |
Pictorial Continuing Medical Education
Pencil in Cup Deformity in Psoriatic Arthropathy
Firdaus Kamal
A 32 years old male patient presented with asymmetrical polyarthritis for last 4 years which was not responded with NSAIDs and other nonpharmacological management. On examination, there is classical psoriatic lesion over extensor surface of both elbow and shin area (Fig. 1). On further examination, he reveals pitting of nail (Fig. 2), onycolysis and shortening of left ring finger (Fig. 3) due to the disease process.
Overall disease severity score was quite high with BASDAI 6.2, DAPSAI 21. He was treated with tablet methotrexate and sulphasalazine for last 6 months. His X-ray of left hand shows classical pencil in cup deformity (Fig. 4). Later on, he was treated with three doses of infliximab. Currently he is pain free and fully independent.
Fig. 1: Classical psoriatic lesion over extensor surface of both elbow and shin area
Fig. 2: Pitting of nail
Fig. 3: Onycolysis and shortening of left ring finger
Fig. 4: Classical pencil in cup deformity
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