Pachydermodactyly: a review

Fluorogenic in-situ Labelling of Gelatin Polymer in Aqueous Solution and Hydrogel

Gelatin polymers made from partially degraded collagen are important biomaterials, but their in-situ analysis suffers from uncontrollable covalent labelling and poor spatial-temporal imaging resolution. Herein, three tetrazolate-tagged tetraphenylethylene fluorophores (TPE-TAs) are introduced for practical fluorogenic labelling of gelatin in aqueous phase and hydrogels. These probes with aggregation-induced emission characteristics offer negligible background and elicit turn-on fluorescence by simply mixing with the gelatin in aqueous phase, giving a detection limit of 0.15 mg/L over a linear dynamic range up to 100 mg/L. This method does not work for collagens and causes minimal interference with gelatin properties. Mechanistic studies reveal a key role for multivalent electrostatic interactions between the abundant basic residues in gelatin (e. g., lysine, hydroxylysine, arginine) and anionic tetrazolate moieties of the lipophilic fluorophore synergistically in spatially rigid macromolecular encapsulation to achieve fluorogenic labelling. The AIE strategy by forming non-covalent fluorophore-gelatin complexes was developed for novel hydrogels that exhibited reversible fluorescence in response to dynamic microstructural changes in the hydrogel scaffold upon salting-in/out treatments, and enabled high spatial-temporal imaging of the fiber network in lyophilized samples. This work may open up avenues for in-situ imaging analysis and evaluation of gelatin-based biomaterials during processes such as in vivo degradation and mineralization.

Inflammatory conditions of the pediatric hand and non-inflammatory mimics

Hand involvement can assume an outsized role in the perception and presentation of disease as a result of functional impairment, visual conspicuity and susceptibility to early structural damage. Rheumatologic referral for inflammatory conditions can be delayed because of assumptions of a traumatic, infectious or neoplastic etiology; conversely, initial rheumatologic evaluation might be pursued for many of the same non-inflammatory causes. This pictorial essay highlights inflammatory conditions affecting the pediatric hand, including juvenile idiopathic arthritis, infectious arthritis, systemic connective tissue disorders, and a variety of less common inflammatory diseases, as well as non-inflammatory congenital, vascular, neoplastic and metabolic differential considerations.

Painful pachydermodactyly in a 39-year-old woman: A case report and review of the literature

We chronicle the case of a 39-year-old female who presented to the rheumatology clinic with a history of chronic, symmetrical polyarticular pain in her hands. Meticulous diagnostic workup to exclude ubiquitous culprit aetiologies, such as rheumatoid arthritis and psoriatic arthritis, was performed. A detailed clinical examination was performed and, coupled with the radiological imaging findings, divulged an underlying diagnosis of pachydermodactyly. The patient was commenced on etoricoxib to alleviate the pain, and was advised to avoid repetitive trauma to her hands. The present report delineates a unique case of painful pachydermodactyly, affecting both proximal interphalangeal joints as well as distal interphalangeal joints. To the best of our knowledge, this is the first case from the state of Kuwait. We further review the literature in order to better elucidate the varying clinical manifestations of an elusive and rare rheumatological condition.

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Pachydermodactyly is a rare disease that can be easily misdiagnosed and treated as an inflammatory arthritis leading to the initiation of unnecessary systemic therapies.

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Pachydermodactyly follows a benign course, therefore aggressive therapy is typically not warranted.

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Pachydermodactyly presents a diagnostic challenge due to its ability to mimic several other etiologies that render the same physical finding of progressive proximal interphalangeal joint swelling.

Pachydermodactyly presenting as juvenile idiopathic arthritis in an adolescent man

We present the case of a 17-year-old Asian man diagnosed with pachydermodactyly, a rare digital fibromatosis. Although this is a non-inflammatory periarticular soft tissue disorder, the clinical appearance can mimic inflammatory arthritis. The patient had a 2-year history of fusiform swelling of multiple proximal interphalangeal joints. He was initially diagnosed with juvenile idiopathic arthritis and treated with methotrexate, but a lack of clinical response led to the diagnosis of pachydermodactyly. Recognising this rare condition can prevent unnecessary and potentially harmful treatment.

Heterotopic ossification after local steroid injection

Pachydermodactyly (PDD) is a rare, benign disease associated with progressive swelling of the periarticular soft tissue of phalangeal hand joints typically treated with local steroid injections. We present a case of a 37-year-old man with PDD treated with local steroid injections. He later developed heterotopic ossification and para-articular calcifications in the injection sites. Heterotopic ossification is not associated with PDD nor is it a recognised complication of local steroid injections. This is the first case in literature of heterotopic ossification occurring after local steroid injection and brings to attention a new potential complication of a widely performed procedure.

[Cutaneous disorders caused by physical damage mimicking rheumatic diseases]

The skin is the primary interface between the body and the environment. It is exposed to a variety of external physical factors to which it must respond in a dynamic manner. In the following review such cutaneous reactions to physical damage are discussed under the aspects of rheumatological differential diagnoses. In particular, circumscribed hyperpigmentation and hyperkeratosis, reactive patterns to cold, with or without humidity, and lightning are presented. Most of these disorders do not need extensive laboratory investigations or imaging techniques. Knowledge of such cutaneous disease symptoms due to physical damage prevents overdiagnostics and possible overtreatment.

Pachydermodactyly: a systematic review

INTRODUCTION/OBJECTIVES

Pachydermodactyly is a rare, benign fibromatosis located around the proximal interphalangeal joints. It is often misdiagnosed as juvenile idiopathic arthritis and may cause unnecessary treatments and anxiety in patients. The goal of this paper is to describe this condition through all the existing information in the scientific literature.

METHOD

A systematic review and a descriptive study have been conducted. A systematic research was performed in PubMed, Embase, Cochrane Library and WOS.

RESULTS

Pachydermodactyly was four times more frequent in male subjects and usually started in adolescence. Bilateral presentation was more frequent. History of microtrauma in both hands due to digital manipulation was found in almost half of the patients, many of them showed some neuropsychiatric disorder. In women, the onset happened later, unilateral involvement and family history were more frequent. Swelling of soft tissue without joint implication was found in imaging tests. The progression was usually positive and the treatment included stopping the microtrauma, administrating intralesional corticoids and/or surgery.

CONCLUSIONS

Diagnosis can be established in asymptomatic young patients through a congruent physical exam, regular analytic results and imaging tests that simply show swelling of soft tissue-a biopsy is generally not required for diagnosis. As pachydermodactyly's course is asymptomatic and benign, knowledge about this condition is limited, which increases the likelihood of its underdiagnosis-it is important that clinicians know of pachydermodactyly in order to avoid misdiagnosis.

Pachydermodactyly: A Case Report of a Little-Known and Benign Form of Digital Fibromatosis

BACKGROUND Pachydermodactyly, a benign and self-limiting cause of cutaneous fibromatosis, is an under-recognized condition. This little-known condition is important, as it mimics inflammatory arthropathy. CASE REPORT A 16-year-old male presented with a 2-year history of progressive, asymptomatic soft tissue swelling of the proximal interphalangeal joints (PIPJs) affecting the second to fourth fingers bilaterally. He had participated in kayaking for the last 1-2 years. Physical examination revealed only painless, saccular, subcutaneous swelling around the PIPJs. Plain radiograph and MRI showed cutaneous thickening around the PIPJs, with no evidence of arthropathy. Blood investigations including inflammatory markers and autoimmune panel were normal. Skin biopsy showed thickened collagen in the dermis, acanthosis, and hyperkeratosis. The patient and family opted for observation and cessation of kayaking. Follow-up at 2 years showed stable disease. A diagnosis of pachydermodactyly was made. CONCLUSIONS Progressive, asymptomatic swelling of proximal interphalangeal joints, especially in young males, should prompt the consideration of pachydermodactyly as a potential differential diagnosis. Because of its benign course, correct recognition can help to prevent undue patient anxiety and avoid inappropriate investigation and treatment.

Pachydermodactyly - A Case Report and Review of Literature

Introduction

Pachydermodactyly is an uncommon or under diagnosed variant of digital fibromatosis. It is a benign disease, described by symmetric proximal interphalangeal (PIP) involvement, progressive swelling, absence of inflammation or pain, and without limitation of function. It has been linked in some cases with psychiatric disorders such as obsessive-compulsive disorder or repetitive mechanical stimulation.

Case Report

We aim to report a case of pachydermodactyly that was diagnosed in a young 17-year-old male patient with painless swelling of the digits mainly at PIP joints with hyperkeratosis that was treated conservatively.

Conclusion

Pachydermodactyly is an under diagnosed and underestimated entity; the recognition of a case in clinical practice can prove to be challenging. A high index of suspicion must be kept at all times when no reason for the swelling is found.

Swollen digits due to pachydermodactyly resembling inflammatory arthritis

Pachydermodactyly is a rare digital fibromatosis, characterized by painless, fusiform swelling in proximal interphalangeal joints. Since it may be misdiagnosed as inflammatory arthritis, it is important to call physicians' attention to this rarely seen condition to avoid unnecessary immunosuppressive treatment. Hereby, we present a case of a pachydermodactyly that had been previously followed-up and treated as an inflammatory arthritis for 4 years. We describe the clinical, radiological, and dermoscopic features of the case.

Two Cases of Pachydermodactyly Presenting as Polyarthritis

Pachydermodactyly is characterized by asymptomatic, progressive swelling of the lateral aspects of the 2nd to 4th finger along the proximal interphalangeal (PIP) joint without involving the joint itself. We present 2 interesting cases of patients with periarticular swelling who were initially diagnosed and treated as juvenile idiopathic arthritis (JIA) with subsequent clinical and pathology confirmation of pachydermodactyly. These cases emphasize the importance of considering pachydermodactyly in young patients with development of periarticular swelling and no joint involvement.