A 55-yrs-old woman complains of stiff, aching hands, especially in the morning. Radiographs of the hands reveal expansion at the base of the terminal phalanges & tapering of the proximal phalanges. This patient most likely has

There are three main varieties of psoriatic ahritis (inflammatory ahritis affecting 5 to 42% of patients with psoriasis): asymmetric inflammatory ahritis, symmetric ahritis , and psoriatic spondylitis. The pathology is similar to that seen in RA (early neutrophil and later monocytic synol infiltration). There are no characteristic laboratory abnormalities in patients with psoriatic ahritis, but radiographs, if they reveal features unique to this disease relative to RA, may be diagnostically helpful. Such special features include the pencil-in-cup appearance of the distal terminal phalanx due to cuplike erosions. and bony proliferation with tapering of the proximal phalanx; the proliferation of the bone near osseous erosions, terminal phalyngeal osteolyis, bone proliferation and periostitis, and telescoping of one bone into another (opera-glass deformity). Inflammation of the tendons and ligaments (enthesopathy) is also characteristic. Nonsteroidal anti-inflammatory agents are the therapeutic mainstays; sulfasalazine or methotrexate is often required in difficult cases. Ref - Harrison's internal medicine 20e pg 2571