Rheumatoid arthritis - hands

Case contributed by Dr Samir Benoudina

Presentation

Bilateral hand pain.

Patient Data

Age: 45 years
Gender: Male
X-ray
  • bilateral and symmetrical involvement
  • proximal interphalangeal joint space narrowing  
  • metacarpal heads erosions 
  • metacarpophalangeal joint space narrowing 
  • metacarpophalangeal joint osteopenia 
  • pancarpal and radiocarpal involvement with erosions 
  • carpometacarpal erosion 
  • distal radioulnar joint loss of space  
  • distal interphalangeal joints spared
  • soft tissue swelling

Annotated image
  • bilateral and symmetrical involvement
  • proximal interphalangeal joint space narrowing (yellow arrows)
  • metacarpal heads erosions (red arrows)
  • metacarpophalangeal joint space narrowing (blue arrows)
  • metacarpophalangeal joint osteopenia (green circles)
  • pancarpal and radiocarpal involvement with erosions (yellow circles)
  • carpometacarpal erosion (purple arrows)
  • distal radioulnar joint loss of space (black arrows)
  • distal interphalangeal joints spared
  • soft tissue swelling

Case Discussion

This is a known case of rheumatoid arthritis. Rheumatoid arthritis is a relatively common arthritis with a prevalence of 0.5-1% and female preponderance. There are a number of classical imaging features in the hands, as illustrated in this case.

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