case_images: PMC2760131_01
case_images: Symmetric polyarticular psoriatic arthritis affecting all the proximal interphalangeal joints of the fingers except the left ring finger PIP joint which seems to be protected by wearing a golden ring. Psoriatic nail changes are also evident in this photo.
case_images: CRM2009-518976.001.jpg
case_images: PMC2760131_01_CRM2009-518976.001.jpg
case_images: fig1
case_images: On examination, there was synovitis at the proximal interphalangeal (PIP) joints in a symmetrical distribution of all the fingers of both hands except the PIP joint of the left ring finger (Figure 1). There was also prominent nail (Figure 1) and skin changes consistent with psoriasis.
case_images: MRI of the proximal interphalangeal joints of both hands confirms sparing of the left ring proximal interphalangeal joint. All other proximal interphalangeal joints show marked synovitis and erosions.
case_images: CRM2009-518976.002.jpg
case_images: PMC2760131_01_CRM2009-518976.002.jpg
case_images: fig2
case_images: MRI scan (Figure 2) and ultrasound studies (USs) of the hands confirmed the presence of joint space narrowing and extensive synovitis with articular erosions at the PIPs of all the fingers sparing the left ring finger PIP joint.