Osteitis in psoriasis

: A 56-year-old man was diagnosed with psoriasis, after a year with pain over the manubrium sterni, a stiff neck and shoulders and an increased erythrocyte sedimentation rate. Imaging studies revealed widening and sclerosis of the manubrium sterni, ossification of the insertions of the first ribs and involvement of the sternoclavicular joints. Histological examination of the sternum showed signs of a chronic inflammatory process. Improvement of the skin lesions was accompanied by a reduction of the pain. Psoriasis may be complicated by osteitis/hyperostosis, which may precede the skin lesions. An effective therapy is lacking, although analgetics and antiphlogistics are often useful.