Inflammatory Seronegative Arthritis

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The 83-year-old woman whose hands are shown in photograph A had a severe flare of arthritis in the metacarpophalangeal and proximal interphalangeal (PIP) joints after corticosteroid therapy for her asthma was stopped. The clue to the diagnosis of psoriatic arthritis is in her fingernails, which show both pitting and onycholysis.

The 83-year-old woman whose hands are shown in photograph A had a severe flare of arthritis in the metacarpophalangeal and proximal interphalangeal (PIP) joints after corticosteroid therapy for her asthma was stopped. The clue to the diagnosis of psoriatic arthritis is in her fingernails, which show both pitting and onycholysis.

The woman whose hand is shown in photograph B had inflamed PIP and distal interphalangeal joints, along with severe morning stiffness that improved just slightly with use of the hands as the day wore on. X-ray studies showed sclerosis and erosions, features of both rheumatoid arthritis and osteoarthritis (OA), indicating that the most likely diagnosis was erosive inflammatory OA.