Robust rheumatoid arthritis, also known as arthritis robust or rheumatoid robustus, refers to a rare variant of rheumatoid arthritis with marked subchondral cysts (geodes) and preserved bone density 1,2. Patients remain in good health usually with few - or even no - symptoms, hence the epithet "robust" 2.
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Epidemiology
This entity is very rare, but is thought to occur more often in males, especially those who are involved in physical labor 2.
Clinical presentation
Location and distribution of disease are most predominantly in the wrist (distal radioulnar and radiocarpal joints) and hands (metacarpophalangeal and interphalangeal joints), but may also affect different locations, such as feet. Compared to rheumatoid arthritis, patients present with much more attenuated pain and stiffness, and may even be asymptomatic 2.
Pathology
Etiology is unknown, but thought to be related to manual labor.
Radiographic features
General appearance is typical of rheumatoid arthritis:
bilateral
symmetric
marginal erosions
ulnar deviation of metacarpophalangeal joints
synovial proliferation
Notable differences between the robust form and typical rheumatoid arthritis:
large subchondral cyst formation disproportionate to erosions
lack of osteopenia
History and etymology
This entity was first described by WHD de Haas et al. in 1973 3.
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