Hand Full of Sausages-Forme Frustae of Severe Psoriatic Arthritis: A Case Report

Dactylitis or sausage shaped digits is one of the hallmark features of psoriatic arthritis which occurs in association with psoriasis. This is a report of 50-year-old female, known case of psoriasis vulgaris, presented with complaints of red, painful and swollen digits of both hands since two weeks. She also complained of pain and restricted movements of all small joints of hands since two days. On examination, all the digits were erythematous, tender and swollen. Investigations revealed elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP), negative rheumatoid factor and x-ray hands showed joint space narrowing and soft tissue swelling. Based on Classification Criteria for Psoriatic Arthritis (CASPAR) with score of 3/6, psoriatic arthritis was diagnosed. Further evaluation of other joints revealed features of sacroiliitis in x-ray pelvis. Psoriatic dactylitis involving all digits and as an initial symptom of psoriatic arthritis is rarely reported in literature. Dactylitis involving all the digits may be a forerunner of severe psoriatic arthritis.