DOI: 10.36347/sjmcr.2021.v09i03.015

Pages: 249-251

Some clinical presentations of psoriatic rheumatism are similar to those of rheumatoid arthritis. We report the case of a patient aged 72 years, asthmatic for 40 years, ethyl and chronic smoking who was admitted for chronic arthritis. Clinical examination objectified, peripheral joint syndrome, deformities of the hands and feet. The assessment objectified a biological inflammatory syndrome, a CRP at 69mg/L; Rheumatoid factor at 678 IU and ACPA at 191 IU. The radiological assessment revealed a structural impairment with an aspect of periostitis in juxta-articular spicule, periosteal affixing; with an aspect of «pencil in cup». The diagnosis of psoriatic rheumatism with ACPA positive was retained in this patient. This patient was offered a weekly treatment with etanercep (Enbrel) 50mg subcutaneously. The pencil in cup and spicule aspects were the most important radiographic feature to distinguish psoriatic rheumatism from immunopositive rheumatoid arthritis. This clinical case has shown the usefulness of simple x-rays for the diagnosis of psoriatic rheumatism.