Hands | • Ulnar deviation of the fingers • ‘z’ deformity of the thumb • Swan neck (hyperextended PIP and flexed DIP joints) and boutonnière (flexed PIP and extended MCP joints, hyperextended DIP joint) deformities of the fingers (see Figure 15.4) • ↓ grip strength and ↓ hand function causes disability |
Legs and feet | • Subluxation of the metatarsal heads in feet and claw toes → pain on walking • Baker’s cysts ( |
Spine | Especially cervical spine—causing neck pain, cervical subluxation, and atlanto-axial instability leading to a risk of cord compression. X-rays are required prior to general anaesthesia |
Non-articular features | • Common. Weight ↓, fever, malaise • Rheumatoid nodules (especially extensor surfaces of forearms) • Vasculitis—digital infarction, skin ulcers, mononeuritis • Eye—Sjögren’s syndrome, episcleritis, scleritits • Lungs—pleural effusions, fibrosing alveolitis, nodules • Heart—pericarditis, mitral valve disease, conduction defects • Skin—palmar erythema, vasculitis, rashes • Neurological—nerve entrapment, e.g. carpal tunnel syndrome, mononeuritis, and peripheral neuropathy • Felty’s syndrome Combination of RA, splenomegaly, and leucopenia. Occurs in patients with long-standing RA. Recurrent infections are common. Hypersplenism → anaemia and thrombocytopenia. Associated with lymphadenopathy, pigmentation, and persistent skin ulcers. Splenectomy may improve the neutropenia |
p. 494) at the knee may rupture mimicking DVTHands | • Ulnar deviation of the fingers • ‘z’ deformity of the thumb • Swan neck (hyperextended PIP and flexed DIP joints) and boutonnière (flexed PIP and extended MCP joints, hyperextended DIP joint) deformities of the fingers (see Figure 15.4) • ↓ grip strength and ↓ hand function causes disability |
Legs and feet | • Subluxation of the metatarsal heads in feet and claw toes → pain on walking • Baker’s cysts ( |
Spine | Especially cervical spine—causing neck pain, cervical subluxation, and atlanto-axial instability leading to a risk of cord compression. X-rays are required prior to general anaesthesia |
Non-articular features | • Common. Weight ↓, fever, malaise • Rheumatoid nodules (especially extensor surfaces of forearms) • Vasculitis—digital infarction, skin ulcers, mononeuritis • Eye—Sjögren’s syndrome, episcleritis, scleritits • Lungs—pleural effusions, fibrosing alveolitis, nodules • Heart—pericarditis, mitral valve disease, conduction defects • Skin—palmar erythema, vasculitis, rashes • Neurological—nerve entrapment, e.g. carpal tunnel syndrome, mononeuritis, and peripheral neuropathy • Felty’s syndrome Combination of RA, splenomegaly, and leucopenia. Occurs in patients with long-standing RA. Recurrent infections are common. Hypersplenism → anaemia and thrombocytopenia. Associated with lymphadenopathy, pigmentation, and persistent skin ulcers. Splenectomy may improve the neutropenia |
