For the 2024 Image Competition, the ACR sought images with educational or remarkable manifestations representing a diverse range of pediatric patients with autoimmune, inflammatory, infectious and malignant drivers of rheumatic disease. Here, we showcase the winning images from Latin America and the Caribbean.
Diagnosing Juvenile PsA
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A 13-year-old boy presented with a seven-year history of erythematous and highly hyperkeratotic plaques affecting his palms (A) and soles (D), which was refractory to topical treatments, methotrexate and acitretin, previously prescribed by his dermatologist. He denied any musculoskeletal complaints or systemic symptoms. Physical examination revealed painless, significant wrist enlargements and claw-like flexed fingers, sparing distal interphalangeal joints (C). His hand X-rays showed acroosteolysis (B), and power Doppler ultrasound revealed nail thickening. A diagnosis of palmoplantar psoriasis with subclinical psoriatic arthritis (PsA) was considered.
