Knuckle pads mimic early psoriatic arthritis


Knuckle pads or Garrod’s nodes are a rare, non-inflammatory condition. They consist of benign, well-circumscribed fibro-adipose tissue over the small joints of hands and feet. Knuckle pads may be under-diagnosed and mistaken for early arthritis. The rheumatologist should perform an accurate differential diagnosis in which he can be helped by ultrasound and by other colleagues, such as the dermatologist. Ultrasound is considered useful in the assessment of the thickening of the subcutaneous tissue, located usually on the extensor site of proximal interphalangeal and metacarpophalangeal hand joints. Dermoscopy may play a role in detecting epidermal and dermal changes. We hereby report the case of a female patient with knuckle pads mimicking psoriatic arthritis.



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Zabotti A, McGonagle DG, Giovannini I, et al. Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia. RMD Open. 2019; 5: e001067. DOI:

Nenoff P, Woitek G. Knuckle Pads [Internet]. Massachusetts Medical Society; 2011 [cited 2021 Jan 6]. Available from:

Zabotti A, Errichetti E, Cereser L, et al. Pachydermodactyly: the role of ultrasonography and dermoscopy for diagnosis. Rheumatology. 2017; 56: 703-703.

Hyman CH, Cohen PR. Report of a family with idiopathic knuckle pads and review of idiopathic and disease-associated knuckle pads. Dermatol Online J 2013; 19: 18177.

Lopez-Ben R, Dehghanpisheh K, Chatham WW, et al. Ultrasound appearance of knuckle pads. Skeletal Radiol. 2006; 35: 823-7. DOI:

Zabotti A, Piga M, Canzoni M, et al. Ultrasonography in psoriatic arthritis: which sites should we scan? Annals of the Rheumatic Diseases. 2018; 77: 1537-8. DOI:

Savage L, Tinazzi I, Zabotti A, et al. Defining pre-clinical psoriatic arthritis in an integrated dermato-rheumatology environment. J Clin Med Multidis Digital Publ Inst. 2020; 9: 3262.

Zabotti A, Errichetti E, Zuliani F, et al. Early psoriatic arthritis versus early seronegative rheumatoid arthritis: role of dermoscopy combined with ultrasonography for differential diagnosis. J Rheumatol. 2018; 45: 648-54. DOI:

Errichetti E, Zabotti A, Stinco G, et al. Dermoscopy of nail fold and elbow in the differential diagnosis of early psoriatic arthritis sine psoriasis and early rheumatoid arthritis. J Dermatol. 2016; 43: 1217-20. DOI:

Kodama BF, Gentry RH, Fitzpatrick JE. Papules and plaques over the joint spaces. Knuckle pads (heloderma). Arch Dermatol. 1993; 129: 1044-5, 1047.

Keersmaeker AD, Vanhoenacker F. Imaging Features of Knuckle Pads. J Belgian Soc Radiol. 2016; 100: 67. DOI:

Hasbún C, Sandoval M, Curi M. A novel treatment for idiopathic knuckle pads with cantharidin-podophylotoxin-salicylic acid. Pediatr Dermatol. 2019; 36: 544-5. DOI:

Weiss E. A novel treatment for knuckle pads with intralesional fluorouracil. Arch Dermatol. 2007; 143: 1447. DOI:

Case Reports
Knuckle pads, Garrod’s nodes, psoriatic arthritis, ultrasound, dermoscopy.
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How to Cite
Giovannini, I., Zandonella Callegher, S., Errichetti, E., De Vita, S., & Zabotti, A. (2021). Knuckle pads mimic early psoriatic arthritis. Reumatismo, 73(1), 67-69.