¹Samah Allam, ²Maria Al-Salmi, ³Haifa Hannawi, ^{3, 4}Suad Hannawi

¹Al-Qassimi hospital, Emirates Health Services (EHS), ²Medical and Health Sciences, Sharjah University, ³Al Kuwait-Dubai (Al Baraha) Hospital, Emirates Health Services (EHS), ⁴Ministry of Health and Prevention (MOHAP)

Introduction: Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease associated with psoriasis (PsO). Ocular manifestations associated with psoriasis. The most common clinical ocular change associated with psoriasis is keratoconjunctivitis sicca (dry eye syndrome), which is present in 18.75% of patients, and blepharitis. Other changes include conjunctivitis, uveitis, punctate keratitis, pinguecula, cataracts, glaucoma, corneal abscesses, pterygium, or abnormalities of retinal vascularization. Papilledema and raised intracranial pressure (ICP) is not a common change that occurs in association with PsO and PsA. There was one previous case report highlighting the association of PsO with raised ICP and papilledema.

Method(s): We are presenting another case of PsA and raised ICP and papilledema

Result(s): A 48 years old Emirati lady, diagnosed with a case of skin and scalp PsO at age of 12 years, later the skin PsO disappeared but the scalp PsO persisted.  She presented to the rheumatology clinic of Al-Kuwait Dubai (Al-Baraha) hospital, with right shoulder pain with limitation in movement, and discoloration of fingers with cold; Raynaud’s phenomenon. She also has a history of left elbow tendinitis and positive family history for psoriasis in a number of her first degree relatives.

Blood tests show erythrocyte sedimentation rate; ESR  of13 mmHg (reference range; RR 0-20), C-reactive protein; CRP 3.1 mg/L (RR 0-3), negative rheumatoid factor; RF, Anti-citrullinated peptide; anti-CCP, antinuclear antibody; ANA, double strand-DNA antibody; DsDNA, extended extra-nuclear antigen; ENA, and anti-cardiolipin.

Magnetic resonance imaging (MRI) of the right shoulder revealed Supraspinatus tendinopathy,  supraspinatus calcific tendinitis ,  Mild glenohumeral joint effusion,  Subacromial–subdeltoid, subcoracoid bursitis , Mild biceps tenosynovitis

One month prior to her presentation to the rheumatology clinic, she was seen by the ophthalmology clinic for vertigo, dizziness, and blurring of vision while working on the computer. Ophthalmology examination revealed bilateral papilledema. Lumbar puncture was performed to check cerebrospinal fluid; CSF pressure which was found to be 36 cm. Diagnosis of Idiopathic ICP was made and she was started on drug therapy with Acetazolamide, with up titration of dose to 500mg BID. Repeated optic fundus examination revealed that optic disc papilledema was less in the left eye only with mild blurry disc upper temporal region.

Conclusion(s): Papilledema and raised ICP might be a rare comorbidity of PsO and PsA.