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There have been reports suggesting that trauma or ‘deep Koebner phenomenon’ can precipitate the development of psoriatic arthritis (PsA).1 Both psoriasis and PsA have strong genetic associations, but there are no studies or reports on any potential interaction between environmental injury and genetics in the development of PsA. We describe the cases of identical twins with psoriasis who each developed PsA of the respective right and left second toes following foot injury.
A 54-year-old woman with a 15-year history of psoriasis kicked a table leg with her right foot. Thereafter, she developed pain and swelling of the second toe. X-ray of the foot did not show any fractures. An ultrasound showed marked synovitis of the right second toe with associated plantar plate rupture. She subsequently had surgical repair of the plantar plate, but the pain and swelling persisted. …
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