Rheumatoid Arthritis of the Hand

Question 1

three stages to RA

Answer 1

1. synovitis and tenosynovitis
2. erosions of joints
3. joint instability and tendon rupture

Question 2

describe stage 1 of RA (synovitis and tenosynovitis)

Answer 2

inflammation leads to swelling and pain in affected structures

Question 3

describe phase 2 of RA (erosion of joints)

Answer 3

inflammatory pannus denudes the joints of articular cartilage

Question 4

describe phase 3 of RA (joint instability and tendon rupture)

Answer 4

progressive destruction of bony and soft tissue structures can progress to subluxation and chronic tenosynovitis predisposes to extensor tendon ruptures (presents with dropped finger and weak wrist extension)

Question 5

why is end stage RA becoming less common?

Answer 5

DMARDs

Question 6

what joint of the hand is spared in RA?

Answer 6

DIPs

Question 7

end stage deformities in RA

Answer 7

• volar MCPJ subluxation
• ulnar deviation
• swan neck deformity (hyperextension at PIPJ with flexion at DIPJ)
• boutonniere deformity (flexion at PIPJ with hyperextension at DIPJ)
• Z-shaped thumb

Question 8

management of RA

Answer 8

• tenosynovectomy (excision of synovial tendon sheath) may prevent tendon rupture
• tendon transfers and joint fusions may be required to preserve function if tendon ruptures
• soft tissue release may be required for contractures

Question 9

when do rheumatoid nodules appear?

Answer 9

appear around joints in RA associated with repetitive trauma

Question 10

do rheumatoid nodules respond to DMARDs?

Answer 10

no

Question 11

management of rheumatoid nodules

Answer 11

excision only if problematic

high rate of reoccurrence