What causes Whiskering in the musculoskeletal system on plain radiography?
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Answer:
Fluffy periostitis at tendon and ligament insertions (enthesitis), classically seen in psoriatic arthritis, a seronegative spondyloarthropathy associated with psoriasis, presenting with enthesitis, peripheral arthritis, dactylitis, and axial involvement. The same finding is also seen more broadly across the seronegative spondyloarthropathies (reactive arthritis, ankylosing spondylitis) and in diffuse idiopathic skeletal hyperostosis (DISH), reflecting its underlying mechanism of enthesitis/enthesopathy rather than being exclusive to psoriatic arthritis.
Why is it called so?
Whiskering refers to the irregular, fluffy, whisker-like projections of periosteal new bone formation emanating from tendon and ligament insertions, resembling whiskers on a face.
Pathophysiology
Chronic inflammation at entheses leads to periosteal reaction with fluffy ossification and proliferation at sites of tendon/ligament attachment, driven by cytokines and mechanical stress; this enthesitis-driven process is characteristic of the seronegative spondyloarthropathy group, most classically psoriatic arthritis.
Alternative names: Fluffy periostitis; spiculated/frayed periosteal appearance.
Other associated named signs: Mouse ear sign (rounded marginal erosion with adjacent periosteal new bone at the distal interphalangeal joint, seen in psoriatic arthritis); pencil-in-cup deformity; sausage digit (dactylitis).
References
Access all radiology signs posted so far: https://radiogyan.com/radiology-signs/
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