Rheumatology International

, Volume 30, Issue 10, pp 1367–1370 | Cite as

Two cases of distal extremity swelling with pitting oedema in psoriatic arthritis: the different pathological mechanisms

  • L. Quarta
  • A. Corrado
  • F. d’Onofrio
  • N. Maruotti
  • Francesco Paolo Cantatore
Case Report


In psoriatic arthritis, swelling and pitting oedema may be caused by different pathogenic mechanisms: on one hand, the involvement of tenosynovial structures; on the other hand, the involvement of lymphatic vessels, which may be rarely implicated by the inflammatory process. This different involvement is responsible for a different response to therapy and a different clinical outcome. In fact, patients with inflammation of the tenosynovial structures and normal lymphatic drainage have a more favourable clinical outcome and response to pharmacologic treatment, whilst patients affected by psoriatic arthritis with chronic lymphatic vascular damage are characterized usually by resistance of oedema to therapy. In this study, we report two cases of psoriatic arthritis with distal extremity swelling and pitting oedema. In the first patient, the swelling and pitting oedema were associated with lymphatic obstruction, as detected by lymphoscintigraphy. In the second, the predominant involvement of the tenosynovial structures, as shown by magnetic resonance, with normal lymphatic flow, may have been the cause of arthritis with oedema. These different pathogenetic mechanisms were associated with different response to therapy. Nevertheless, oedema was resistant to therapy in both patients probably because of other unknown factors, which influence therapy and clinical outcome.


Arthritis Lymphoedema Pathogenesis Psoriasis 


  1. 1.
    Griller B, Dequeker J (1987) Rheumatoid lymphedema. J Rheumatol 14:1095–1097Google Scholar
  2. 2.
    Bamji A (1991) Limb lymphoedema in rheumatoid arthritis. Ann Rheum Dis 50:407CrossRefPubMedGoogle Scholar
  3. 3.
    Bohm M, Riemann B, Luger TA, Bosmann G (2000) Bilateral upper limb lymphoedema associated with psoriatic arthritis: a case report and review of the literature. Br J Dermatol 143:1297–1301CrossRefPubMedGoogle Scholar
  4. 4.
    Kiely PDW, Joseph AEA, Mortimer PS, Bourke BE (1994) Upper limb lymphedema associated with polyarthritis of rheumatoid type. J Rheumatol 21:1043–1045PubMedGoogle Scholar
  5. 5.
    Mulherin DM, FitzGerald O, Bresnihan B (1993) Lymphedema of the upper limb in patients with psoriatic arthritis. Semin Arth Rheum 22:350–356CrossRefGoogle Scholar
  6. 6.
    Salvarani C, Macchioni P, Veneziani M et al (1990) Upper limb lymphedema in psoriatic arthritis. J Rheumatol 17:273–274PubMedGoogle Scholar
  7. 7.
    Salvarani C (1995) Upper limb lymphedema in inflammatory arthropathy. J Rheumatol 22:230 (letter)Google Scholar
  8. 8.
    Yamamoto T, Nishioka K (2002) Psoriasis arthropathy and lymphedema. J Dermatol 29:812–814PubMedGoogle Scholar
  9. 9.
    Salvarani C, Cantini F, Olivieri I, Niccoli L, Senesi C, Macchioni L et al (1999) Distal extremity swelling with pitting oedema in psoriatic arthritis: evidence of 2 pathological mechanisms. J Rheumatol 26:1831–1834PubMedGoogle Scholar
  10. 10.
    Kiely PDW, Bland JM, Joseph AEA, Mortimer PS, Bourke BE (1995) Upper limb lymphatic function in inflammatory arthritis. J Rheumatol 22:214–217PubMedGoogle Scholar
  11. 11.
    McCarty DJ, O’Duffy DI, Pearson L, Hunter IB (1985) Remitting seronegative symmetrical synovitis with pitting edema. JAMA 254:2763–2767CrossRefPubMedGoogle Scholar
  12. 12.
    Cantini F, Niccoli L, Olivieri I et al (1997) Remitting distal lower extremity swelling with pitting oedema in acute sarcoidosis. Ann Rheum Dis 56:566 (letter)CrossRefGoogle Scholar
  13. 13.
    Olivieri I, Padula A, Pierro A, Favaro L, Oranges GS, Ferri S (1995) Late-onset undifferentiated seronegative spondyloarthropathy. J Rheumatol 22:899–903PubMedGoogle Scholar
  14. 14.
    Salvarani C, Gabriel S, Hunder GG (1996) Distal extremity swelling with pitting edema in polymyalgia rheumatica. Arthritis Rheum 39:73–80CrossRefPubMedGoogle Scholar
  15. 15.
    Stanton AWB, Levick JR, Mortimer PS (1996) Current puzzles presented by postmastectomy oedema (breast cancer related lymphoedema). Vasc Med 1:213–225PubMedGoogle Scholar
  16. 16.
    Braun-Falco O, Christopher E (1974) Structural aspects of initial psoriatic lesions. Arch Dermatol Forsch 251:95–110PubMedGoogle Scholar
  17. 17.
    Braverman IM, Yen A (1974) Microcirculation in psoriatic skin. J Invest Dermatol 62:493–502CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • L. Quarta
    • 1
  • A. Corrado
    • 1
  • F. d’Onofrio
    • 1
  • N. Maruotti
    • 1
  • Francesco Paolo Cantatore
    • 1
    • 2
  1. 1.Department of RheumatologyUniversity of Foggia Medical SchoolFoggiaItaly
  2. 2.Rheumatology Clinic “Mario Carrozzo”“D’Avanzo” HospitalFoggiaItaly

Personalised recommendations