Korean J Dermatol.  2019 Aug;57(7):378-382.

Pustulotic Arthro-osteitis Improved with Anti TNF-α Inhibitor

• Park HS
• Kim JH
• Kim HW
• Kim SC

Abstract

Pustulotic arthro-osteitis (PAO) is a rare chronic inflammatory disorder characterized by inflammatory osteitis of the sternoclavicular joint and palmoplantar pustulosis. Here, we report a case of PAO that was successfully treated with a TNF-α inhibitor. A 45-year-old man presented with a 3-month history of pustular eruption on the palms and soles. Physical examination showed multiple erythematous papulopustules on the palms, back, and left shin, accompanied by sternoclavicular joint swelling and tenderness. Skin biopsy showed intraepidermal pustules filled with neutrophils on the palm. Bone scintigraphy revealed increased uptake in the bilateral sternoclavicular and other axial joints. Based on these findings, we made the diagnosis of PAO. Even after 6-month treatment of oral steroids and cyclosporine, skin manifestations insufficiently improved, so etanercept therapy was started. Complete clearance of skin lesions and joint pain were achieved after 3 months of etanercept therapy.

Keyword

Pustulotic arthro-osteitis; Anti-TNF-α inhibitor

MeSH Terms

Arthralgia
Biopsy
Cyclosporine
Diagnosis
Etanercept
Humans
Joints
Middle Aged
Neutrophils
Osteitis
Physical Examination
Radionuclide Imaging
Skin
Skin Manifestations
Sternoclavicular Joint
Steroids
Cyclosporine
Etanercept
Steroids