[Massive osteolysis of the metacarpal bones. Apropos of a case of an osteolytic form of psoriatic rheumatism].

The authors report a case of massive osteolysis of all of the metacarpal bones of the right hand in a 26 year old man. The disease commenced 9 years previously with painful symptoms associated with inflammation and the initial X-rays showed periosteal reaction of the 2nd and 3rd metacarpals. Massive osteolysis of all of the metacarpal bones, including the 1st metacarpal, developed progressively over a period of one year, although no signs of osteolysis were observed in the carpal bones or phalanges. A surgical operation, performed to realign the ring and little fingers, revealed a 4 mm thick periosteal sheath explaining the maintenance of a certain degree of stability of the metacarpals despite the massive osteolysis. Histological examination eliminated any neoplastic or infectious aetiology and confirmed the inflammatory origin with vascular and lymphocytic proliferation. The development of palmo-plantar psoriasis several months after the onset of the painful symptoms suggested the diagnosis of psoriatic rheumatism. This is a rare site with an unusual clinical course with massive osteolysis of all of the metacarpal bones, but it appears to be the most likely hypothesis. The clinical course was stabilised by non-steroidal anti-inflammatory agents but there was no bony reconstruction.