Osteolysis of the terminal phalanges of the hand.

A 56-year-old woman presented to the hand clinic, with a 6-month history of progressive painful and swollen acra, resulting in a weakened grip. Her medical history included psoriasis vulgaris since 2006, with progressively worsening skin abnormalities. She could not relate the symptoms to any history of trauma. On examination, she had painful and swollen digits 1 and 3 on the left and digits 1, 3 and 4 on the right hand, including typical nail abnormalities (figure 1). C reactive protein, erythrocyte sedimentation rate and parathyroid hormone were …