Psoriatic arthritis – hands

Psoriatic arthritis. This differs from rheumatoid arthritis in several ways: it characteristically (but not always) affects the distal interphalangeal joints, whereas these are always spared in RA; it is often asymmetrical, as in this case; and when advanced it commonly results in a so-called ‘pencil-in-cup’ appearance, usually at the MCP joints – as in the right second, third and fourth fingers in this example.