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Hand & Wrist Exam

Rheumatoid Arthritis

July 7th, 2019
On this page:Complications


  • Signs of Rheumatoid Arthritis

  • General Signs

  • Symmetrical arthropathy with sparing of DIP joints
  • Prominence of the ulnar styloid
  • Radial deviation of the wrist
  • Ulnar (medial) deviation of the MCP joints
  • Volar (palmar) subluxation of the MCP joints
  • Swan neck deformity: hyperextension at the PIP joint with flexion at the MCP and DIP joints
  • Boutonniere deformity: flexion at the PIP joints with hyperextension at the MCP and DIP joints
  • Z-thumb deformity: flexion at the IP joint of the thumb with hyperextension at the MCP joint
  • Signs of Complications

  • Evidence of compressive neuropathy - e.g. signs of carpal tunnel syndrome
  • Evidence of vasculitis - palpable purpura
  • Evidence of interstitial lung disease - fine fibrotic crepitations
  • Splenomegaly (Felty's syndrome)
  • Signs of Severity

  • Evidence of active synovitis
  • Severe deformity
  • Rheumatoid nodules (indicate seropositive disease)
  • X-Ray Findings in Rheumatoid Arthritis

  • Reduced joint space - generally symmetric
  • Articular surface erosions: discontinuities in the bone plate
  • Periarticular osteopaenia - hypodensity of bone surrounding the joint
  • Soft tissue swelling


  • Complications of Rheumatoid Arthritis

  • Ocular - sicca symptoms, scleritis, episcleritis, scleromalacia, scleromalacia perforans
  • Vasculitis - palpable purpura, distal gangrene, mononeuritis multiplex
  • Neurologic - compressive neuropathies (e.g. carpal tunnel syndrome)
  • Pulmonary - interstitial lung disease, pleural effusions, lung nodules
  • Felty's syndrome (arthritis, splenomegaly and neutropaenia)
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