Overview
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
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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