Therapeutic Challenges and Complications in a Case of Arthritis Mutilans

Abstract

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.