Psoriatic Arthritis With Dactylitis: A Case Report and Concise Review of Treatment Options

Dactylitis is characterized by generalized swelling of a finger or toe. Though it is commonly seen, the literature on psoriatic dactylitis is scant, with the majority consisting of solitary case reports. The literature on the treatment of dactylitis is considerably more limited. Dactylitis usually responds to non-steroidal anti-inflammatory drugs (NSAIDs) or traditional disease-modifying antirheumatic drugs (DMARDs). Numerous randomized studies have lately shown the effectiveness of different biological agents in the treatment and maintenance of psoriatic arthritis (PsA) and associated dactylitis. In primary care practice, a patient may present with dactylitis without a history of psoriasis. In such cases, an attempt should be made to detect the underlying psoriasis by looking for a psoriatic patch in hidden areas viz. skin folds, groin or scalp. Here, we describe a case of PsA with dactylitis in this case report, with an emphasis on treatment and outcome. We also attempted to focus on the various treatment options for dactylitis.

Cutaneous manifestations of mixed connective tissue disease: study from a tertiary care hospital in eastern India

Context:

Mixed connective tissue disorder is an uncommon disease. Some scientists are reluctant to recognize it as a separate entity. Some others have defined this ailment. Cutaneous features of this condition are unique. Researchers from India have described these features to relate to those described in the studies from other parts of the globe.

Aims:

This study aims to delineate the skin manifestations of clearly defined mixed connective tissue disease (MCTD) patients, to compare them with those established as overlap syndrome, and to relate them with studies from other parts of the globe.

Settings and Design:

Successive patients who fulfilled the specific criteria for MCTD presenting in the skin outpatient department of a tertiary care hospital in eastern India were clinically examined from 2009 for 3 years.

Materials and Methods:

The number of participants was 23 and the dermatological features of these were compared with 22 patients with overlap syndrome. The antibody to uridine-rich U1 ribonucleoprotein was measured for all patients.

Statistical Analysis Used:

SPSS (Version 17) and MedCalc (Version 11.6).

Results:

The Male: Female ratio among the MCTD patients was 1:6.67 and that of the overlap syndrome was 1:10. Twenty patients of the MCTD group presented with synovitis as against only seven in the overlap group. Raynaud's phenomenon was present in some of the subjects. Puffy fingers were rare in our study. Facial numbness was reported by four of those suffering from MCTD. Antinuclear antibody (ANA) was essentially of a speckled pattern in this disease

Conclusions:

Cutaneous indicators of MCTD are distinct from overlap syndrome. Knowledge of these manifestations prevalent in a region may lead to early diagnosis of the disease.