Osteolysis of the terminal phalanges of the hand.

To cite: Mol S, Kraan G. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2016-214527 DESCRIPTION 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 not raised. Radiographs and MRI showed severe osteolytic lesions of the distal phalanx of digits 1 and 3 on the right and digit 1 on the left hand (figure 2). Additionally, a technetium bone-scan and single photon emission CT showed increased activity in several terminal phalanges (figure 3). A biopsy of the right index finger showed an inflammatory reactive process, with no