Rheumatoid arthritis of the wrist joint

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Bilateral wrist pain and swelling.

Patient Data

Age: 49 years
Gender: Female
Modality: X-ray

Frontal radiograph of the hands shows severe osteopenia with soft tissue swelling around the wrists, erosion of the distal radius and ulna, severe narrowing of the readiocarpal joint with carpal ankylosis and destruction of the intercarpal articulations.

Frontal radiograph of the chest shows subtle erosion of the distal ends of the clavicles.

 

Modality: MRI

Marked radiocarpal, ulnocarpal and distal radioulnar joints’ synovial thickening and proliferation with heterogeneous enhancement as well as mild joint effusion is noted  associated with destruction and erosion of the distal radius, ulna and their styloid processes.  

Fusion and erosion of the carpal bones as well as ankylosis and destruction of the intercarpal joints is noted with heterogenous enhancement. 

Tenosynovitis of the opponents abductor pollicis and extensor carpi radialis tendons. 

A 4.0 x 2.5 x 3.0 cm. cystic lesion is seen related to the dorso radial aspect of the wrist joints, the cystic lesion shows heterogeneously hypointense T1 and hyperintense T2, PDFS and GRE signal with multiple T2 hypointense internal structures (rice bodies).  

Intact carpal tunnel.  

Intact rest of the flexor and extensor tendons with no definite tendon tear.  

Case Discussion

Severe rheumatoid arthritis of the wrist joint with significant synovial thickening, erosion of the distal radius and ulna and their styloid processes as well as fusion and erosion of the carpal bones with tenosynovitis and bursitis or ganglion cyst.

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Case Information

rID: 38576
Case created: 26th Jul 2015
Last edited: 17th Sep 2015
Inclusion in quiz mode: Included

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