Bilateral upper limb lymphoedema associated with psoriatic arthritis: a case report and review of the literature

Lymphoedema is an unusual extra-articular feature of rheumatoid arthritis a nd has rarely been described in psoriatic arthritis. We report a 41-year-ol d man with psoriasis and psoriatic arthritis who developed bilateral lympho edema of the upper extremities. Lymphoscintigraphy showed absent lymphatic drainage in the right arm and a subnormal increase in lymphatic flow under manual exertion in both arms. Colour Doppler ultrasound studies did not rev eal venous or arterial abnormalities. Conservative management and therapy w ith cyclosporin (for worsening arthritis) resulted in partial resolution of the lymphoedema and improvement of flow parameters on the right side upon repeat lymphoscintigraphy.