Arthritis Mutilans: The Devastating Face of Psoriatic Arthritis

Abstract

Psoriatic arthritis is a heterogeneous seronegative spondyloarthropathy that affects up to one-third of patients with cutaneous psoriasis. The rarest and most destructive subtype of arthritis is arthritis mutilans, which results in shortened, flail, telescoping digits as a result of unremitting osteolysis of the phalanges and metacarpals. This results in the classical "opera-glass hand." We present the clinical photograph and corresponding plain radiograph of the hands in a patient with long-standing psoriatic arthritis. The images demonstrate gross digital shortening, nail dystrophy, and cutaneous psoriasis, as well as widespread bone resorption, pencil-in-cup deformities, and acro-osteolysis. The images serve as a reminder that psoriasis is not restricted to the skin and that the deformity depicted here is now largely preventable through the opportune escalation of disease-modifying therapy and early recognition.