Both hands-Typical findings of rheumatoid arthritis are seen in this oblique projection of both hands. Bilateral and symmetric, destructive, erosive arthritis affecting multiple joints of both hands, carpus and wrists. The affected joints show marginal and central articular erosions with soft tissue swelling and peri-articular osteopenia. Concentric joint space loss with subchondral cysts. Multiple deformities at the affected joints, including ulnar deviation at the MCP joints.
X-ray of right hand in this advanced case, shows involvement of wrist, radio-ulnar, carpal, CMP joints. Pannus commonly destroys ulnar styloid, as in this case. Note uniform loss of joint space, in contrast to asymmetric loss in osteoarthritis. Note typical joint deformities eg Boutonniere deformity at the thumb (see discussion).
X-ray of left hand- Note 'swan-neck' deformity at little and index finger. This is seen as hyper-extended PIP and flexed DIP and MCP joints (see discussion).