Psoriatic Arthritis in Hands and Fingers of a 38-Year-Old Woman

A 38-year-old woman had become increasingly depressed by worsening psoriasis in conjunction with a flare of arthritis in her hands and fingers. The patient complained that she could not function optimally and that her quality of life had diminished.

The psoriasis had not responded to topical corticosteroids or ultraviolet light therapy, and the symptoms seemed to intensify during times of stress. Erythema, dryness, and scaling on the dorsum of both hands and psoriatic lesions on the nail beds of all fingers were noted.

Gopi Rana-Mukkavilli, MD of New York City comments that psoriasis affects up to 3% of the population.¹ It is considered an idiopathic, benign, epidermal hyperproliferation.

Generally, the disease develops in young adults who will experience lifelong remissions and exacerbations.

Psoriatic arthritis may be inherited; multiple genetic and environmental factors are required for expression of the trait. Factors associated with exacerbations include certain drugs, such a chloroquine and β-blockers; local trauma; and infection.

Psoriatic arthritis lesions are found on the skin and nails; the fingers and toes are affected most often. Arthritis symptoms and psoriatic flares may arise independently or concurrently. This patient was given calcipotriene, a topical vitamin D analog cream. Significant improvement was noted after a 6-week course of twice daily applications to the skin lesions and nail beds. The patient also reported that her quality of life had improved, and her general demeanor had brightened.

REFERENCE:1. Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. Companion Handbook. New York: McGraw-Hill; 1998.