Rheumatoid Arthritis of the Hands

Question 1

What joints does RA tend to spare in the hands?

Answer 1

DIPs

Question 2

Natural history of RA

Answer 2

1. Synovitis and tenosynovitis
2. Erosions of joints
3. Joint instability and tendon rupture

Question 3

Treatment of RA

Answer 3

DMARDs
Surgery: tenosynovectomy to prevent tendon rupture, tendon transfers, joint fusions, soft tissue releases, PIP replacements, resection of the distal ulnar in DRUJ arthritis

Question 4

Deformities identified on clinical examination of RA in the hands

Answer 4

Volar MCPJ sublaxation
Ulnar deviation
Swan neck deformity (hyperextension at PIPJ with flexion DIPJ)
Boutonniere deformity (flexion at PIPJ with hyperextension at DIPJ)
Z-shaped thumb