What is the arthritis mutilans pattern of psoriatic arthritis?

Updated: Jan 24, 2022
  • Author: Anwar Al Hammadi, MD, FRCPC; Chief Editor: Herbert S Diamond, MD  more...
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Answer

This is a rare form of psoriatic arthritis, being found in only 1-5% of patients (although some reports suggest that arthritis mutilans may occur in as many as 16% of patients and may be as severe as RA).

In arthritis mutilans, resorption of bone (osteolysis), with dissolution of the joint, is observed as the "pencil-in-cup" radiographic finding and leads to redundant, overlying skin with a telescoping motion of the digit. (The effects of arthritis mutilans appear in the images below.)

Arthritis mutilans, a typically psoriatic pattern Arthritis mutilans, a typically psoriatic pattern of arthritis, which is associated with a characteristic "pencil-in-cup" radiographic appearance of digits.
Severe psoriatic arthritis showing involvement of Severe psoriatic arthritis showing involvement of the distal interphalangeal joints, distal flexion deformity, and telescoping of the left third, fourth, and fifth digits due to destruction of joint tissue.
Arthritis mutilans (ie, "pencil-in-cup" deformitie Arthritis mutilans (ie, "pencil-in-cup" deformities).

This "opera-glass hand" is more common in men than in women and is more frequent in early-onset disease.


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