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Images in rheumatology
Mutilating arthropathy with skin nodules
  1. Tsz On Lam,
  2. Edric Chi Ching Ip,
  3. Wendy Wan Hang Lau,
  4. Agnes Wai Sze Chan,
  5. Christina Man Tung Cheung,
  6. Joshua Jing Xi Li,
  7. Joanna Ka Man Ng,
  8. Lai-Shan Tam
  1. The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
  1. Correspondence to Professor Lai-Shan Tam; tamls_813{at}yahoo.com

https://doi.org/10.1136/ard-2024-226186

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    Presentation

    A 68-year-old woman attended the rheumatology clinic for hand polyarthralgia and deformity for over 1 year, together with weight loss of 10 kg in the past 6 months. On examination, there were no tender or swollen joints. There were deformities over multiple proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, as well as innumerable soft papulonodular skin lesions over her hands (figure 1A), arms and face. These lesions did not appear on the lower extremities. There was no mucosal lesion in the oral or anterior nasal cavity. These skin lesions also began 1 year ago, similar to the onset of joint symptoms. There was no psoriasiform rash. The radiograph of her hands (figure 1B) revealed bony erosions at multiple DIP joints, PIP joints, metacarpal and carpal bones. There was bone …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors TOL and L-ST took the lead in writing this manuscript and patient management. ECCI, WWHL, AWSC and CMTC provided dermatological assessment and performed the skin biopsy. JJXL and JKMN performed the histological analysis and provided the histopathological photos and descriptions. L-ST is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement statement The patient of this case participated in the consent to provision of her clinical information. There was no public involvement.

    • Provenance and peer review Not commissioned; externally peer reviewed.