Presentation
10 years history of joints stiffness and pain affecting hands and elbows.
Patient Data
There is a predominantly proximal erosive polyarthropathy with erosion seen in relation to the proximal ulnar to the distal ulnar, radius, carpal row, with further erosion seen in relation to the heads of the first to fifth metacarpals.
There are multiple joint subluxations with associated swan neck deformities in relation to the right index finger. There is also associated periarticular osteopenia and bone density appears osteopenic for age. The appearances are felt consistent with an erosive polyarthropathy such as rheumatoid arthritis.
Global erosive polyarthropathy is present at the left elbow joint associated with a large anterior effusion and probably a small posterior effusion.
There is collapse at the humeroulnar joint. Alignment is otherwise mostly intact. An acute traumatic fracture is not identified. There is underlying osteopenia.
Case Discussion
Joint deformities can be appreciated in severe rheumatoid arthritis.
In the treatment of thumb metacarpophalangeal arthritis, arthrodesis is a popular and generally reliable surgical solution. In the fingers, arthroplasty remains the most common treatment option. This patient was planned for right index finger PIP arthrodesis and right ring finger PIP arthroplasty after unsuccessful medical management.