Rheumatoid arthritis- hands and knees

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis certain


Chronic bilateral, wrist, hand and knee pain. Ongoing treatment for a known clinical condition.

Patient Data

Age: 50 years
Gender: Female

Features suggestive of rheumatoid arthritis (RA) as evidenced by the symmetric findings of :

Important negative findings:

  • absence of subluxations, dislocations or ulna deviation

  • absence Boutonniere or swan-neck deformities

  • absence of telescoping

Features suggestive of secondary osteoarthritis with a background of rheumatoid arthritis:

  • tri compartmental joint space narrowing on the left

  • bi-compartmental joint space narrowing on the right

  • minimal osteophytes

  • minimal subchondral cysts

  • bilateral supra-patellar effusion

Case Discussion

The patient has known rheumatoid arthritis on treatment. The hand findings are typical of the known diagnosis.

The presence of tri-compartmental secondary osteoarthritis of the knees (in this instance, predominantly the left knee) also alludes to the known diagnosis because of the non-weight-bearing lateral compartmental involvement typical in rheumatoid arthritis. The lack of marginal and often exuberant osteophytes and subchondral cyst formation given the significant joint space reduction that is present, is also another finding suggesting RA.

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