Approach to Joint Examination

Question 1

Tophi

Answer 1

Deposit of uric acid crystals, can be found on DIP joints, ear, back of hands, etc

Question 2

Psoriatic arthritis

Answer 2

Dactilitis - whole digit becomes inflamed (soft tissue sweling)

Question 3

Classic deformities

Answer 3

Swan neck - RA
Bouttoinairs??
Swan neck and B like mirror images
Ulnar deviation of fingers - chronic sign
Swelling of MCPs
Z thumb/deformity
Wasting in hands (particularly obvious around thumb where there is usually a degree of fat and muscle)
Can get some of these in SLE as well - clinically can tell apart because SLE does not tend to be an erosive arthritis (ask them to make a fist of put hands together the deformities go away - more to do with tendon laxity than the joint itself)