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RHEUMATOID ARTHRITIS-UPPER LIMBS

Rheumatology

RHEUMATOID ARTHRITIS-UPPER LIMBS

1. Hands - the arthritis is symmetric and polyarticular. There is specific involvement of the hands-especially the MCP and PIP joints; the DIP joints are spared! Boutonniere and swan-neck deformities occur in advanced disease, although they are nonspecific for RA.

2. Other characteristic deformities - ulnar deviation, volar subluxation, Z deformity of thumb, small muscle wasting, ulnar and median neuropathy.

3. Nails - splinter haemorrhages.
4. Wrist - synovial thickening, Piano key sign (disruption of the radio-ulnar ligament).
5. Elbows - Rheumatoid nodules.
6. Shoulders - tenderness and limited ROM.
7. Axillae - enlarged axillary nodes indicate active disease.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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