The most dramatic and severe form of arthritis associated with psoriasis is arthritis mutilans (AM), which is a rare disorder, affecting very few patients with psoriasis. AM has a predilection for the small joints of the hands and feet. It is generally characterized by seronegative degenerative joint disease, leading to osteolytic changes in the carpal and digital bones. The bone and joint lesions rapidly and progressively cause bone lysis and joint ankylosis with loss of digits, soft-tissue deformities, telescoping of fingers and toes and the hallmark “la main en lorgnette” deformity (opera-glass hand). (1) Arthritis mutilans is characterized by an asymmetric pattern of peripheral joint involvement, with a predilection for the interphalangeal and metacarpophalangeal joints of the hand and small joints of the feet. (2) Characteristic features of AM are severe deformity of the hands, foreshortened fingers with excessive skin folds, hypermobile joints and digits that can be elongated by traction. (3) Radiologically, AM is characterized by severe resorption of the joint with an attendant loss of function, sometimes to a dramatic degree. (4) We present the case of a male patient who with psoriatic lesions onset from almost four decades, followed by involvement of hand and feet joint with important deformities. The treatment was difficult due to important comorbidities.

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BackgroundDegenerative lesions in shoulder rises exponentialy with age and diabetes was found to be associated with shoulder pain [1,2].ObjectivesTo evaluate the prevalence and type of lesions of shoulder in diabetic patients with no pain using ultrasound (US).MethodsWe included consecutive patients with diabetes with no pain or clinical tumefaction in shoulder. US was performed in both shoulders using the standard scanning planes and dynamic maneuvers. Clinical data as fasting glycemia, BMI, treatment were recorded.ResultsForty two shoulders were examined in 21 consecutive patients (mean age 67.92+/-7.35 years, weight 81.75 +/- 13.57 kg, BMI 25+/-2 kg/m2, fasting glycemia 151.85+/-33.72mg/dl) with diabetes diagnosis mean 5.33 years +/- 5.99. Majority of patients were under treatment with oral antidiabetics (58.3%). Degenerative lesions were found in subscapular (SSc) 33.3% and supraspinatus (SpS) 8.3%) tendons as well as intratendinous micro ruptures with calcifications (33.3% bilateral calcifications in SSc, SpS). Impingement syndrome was objectified in 16.6% of examinations. Minimal inflammatory signs as: sub-acromion sub deltoidian bursitis in 50% (minimum in 33.3%, 8.3% bilateral) and long head biceps tenosynovitis in 58.33% (8.3% minimal Doppler signal). 83.3% showed humeral irregularities and also erosions were found (8.3%).ConclusionsDegenerative and minimal inflammatory lesions in shoulder of diabetic patients exist with no clinical sign (pain, tumefaction). Ultrasonography might be an usefull technique to confirm these alterations before the appearance of symptoms.References Thomas SJ, McDougall C, Brown ID, et al. Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elbow Surg. 2007;16:748–751.Abate M, Schiavone C, Salini V. Sonographic evaluation of the shoulder in asymptomatic elderly subjects with diabetes. BMC Musculoskelet Disord. 2010;11:278. Disclosure of InterestNone declared