OSTEOARTICULAR MANIFESTATIONS OF PUSTULOSIS PALMARIS-ET-PLANTARIS ANDOF PSORIASIS - 2 DISTINCT ENTITIES

Objective-To test the hypothesis that pustulosis palmaris ct plantaris and psoriatic arthritis (PsA) are two distinct diseases, and that the associated dermatoses are therefore also distinct diseases. Methods-W e prospectively performed clinical, radiological, biological, and bone scan investigations in 23 outpatients with pustolotic arthritis and 2 3 outpatients with PsA, matched by gender, age (+/- one year) and dura tion of arthritis (+/- two years). Results-The anterior chest wall, es pecially the sternocostoclavicular joints, was more frequently involve d in pustulotic arthritis than in PsA, both clinically (82% v 43%; p < 0.001) and radiologically (47% v 17%; p < 0.05). Sternocostoclavicula r joints generally presented with erosive lesions in PsA, and with lar ge ossifications in pustulotic arthritis. Peripheral joint involvement was mono- or oligoarticular, affecting proximal joints, in pustulotic arthritis (74% v 21%; p < 0.01), and polyarticular, involving small d istal joints, in PsA (60% v 0%; p < 10(-4), in which condition it was also more often erosive (43% v 8%; p < 0.01). The frequency of sacroil iitis and of spine involvement was similar in pustulotic arthritis and PsA. Biology and bone scan did not help distinguish between the two g roups. Conclusions-Pustulotic arthritis and PsA are clinically and rad iologically different, therefore pustulosis palmaris et plantaris and psoriasis are most probably distinct dermatological diseases.