Sudden Upheaval of the Sternocostoclavicular Joint Explicated by Skeletal Scintigraphy in Case of Psoriatic Arthritis

以骨關節閃爍影像呈現胸肋鎖關節驟然隆起：乾癬性關節炎的個案報告

10.6315/TJPMR.202106_49(1).0011

蔡文瑜(Wen-Yu Tsai)；蔡侑霖(Yu-Lin Tsai)；張幸初(Shin-Tsu Chang)

psoriasis ； psoriatic arthritis ； sternocostoclavicular joint ； single-photon emission computed tomography/computed tomography ； palmoplantar pustulosis ； 乾癬（psoriasis） ； 乾癬性關節炎（psoriatic arthritis） ； 胸肋鎖關節（sternocostoclavicular joint） ； 單光子電腦斷層／電腦斷層造影（single-photon emission computed tomography/computed tomography） ； 掌蹠膿疱症（palmoplantar pustulosis）

台灣復健醫學雜誌

49卷1期（2021 / 06 / 01）

119 - 126

英文

Introduction: Psoriatic arthritis (PsA) has been considered a unique inflammatory arthritis associated with psoriasis. Involvement of sternocostoclavicular joint (SCCJ) associated with psoriasis arthritis is often clinically silent and overlooked. We present here a case of PsA involving the SCCJ with an increased SCCJ uptake in scintigraphy. Case presentation: A 54-year-old Asian female, since the onslaught of her first syndrome of arthralgia 8 years ago, presented with flared up episodes of psoriasis arthritis, especially in the knees and distal toes. To her surprise, at the PsA flare-up this time, joint pain and swelling occurred at her right SCCJ, together with some discrete pea-sized skin changes of palmoplantar pustulosis at her left palm. Discussion: To differentiate PsA has flared up from other diseases, other common causes of SCCJ pain with swelling need to be considered. Evidence from hybrid images like single-photon emission computed tomography/computed tomography (SPECT/CT) was used for our differential diagnosis. These images allowed precise localization of abnormal foci of tracer uptake, with meaningful detection of soft-tissue infection, arthritis and osteomyelitis.

介紹：乾癬性關節炎（psoriatic arthritis）為一種發炎性關節炎，其在胸肋鎖關節（sternocostoclavicular joint）的病灶因症狀不明顯而易被忽略，此病例報告介紹一位乾癬（psoriasis）患者，其胸肋鎖關節處有驟然隆起，並在閃爍影像中發現胸肋鎖關節的異常。案例介紹：一名患有乾癬的54歲亞洲女性，八年前第一次關節疼痛，被診斷為乾癬性關節炎，發作位置多在膝蓋和腳趾，在這些年關節痛反覆發生。令她意外的是，這次乾癬性關節炎發作，出現了右側胸肋鎖關節的疼痛和腫脹，而左手掌則出現了豌豆大小散在性的牛皮癬（palmoplantar pustulosis）。討論：為了將乾癬性關節炎復發與其他疾病做鑑別，需考慮常見引發胸肋鎖關節腫痛的疾病，在影像上，單光子電腦斷層／電腦斷層造影（single-photon emission computed tomography/computed tomography）可以幫助鑑別診斷，其對軟組織感染、關節炎和骨髓炎有更精確的病灶定位能力。

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