Robust rheumatoid arthritis

Last revised by Daniel J Bell on 14 Jun 2021

Robust rheumatoid arthritis refers to a rare variant of rheumatoid arthritis with marked subchondral cysts (geodes) and preserved bone density 1,2. Patients remain in good health usually with few - or even no - symptoms, hence the epithet "robust" 2.

This entity is very rare, but is thought to occur more often in males, especially those who are involved in physical labor 2.

Location and distribution of disease are most predominantly in the wrist (distal radioulnar and radiocarpal joints) and hands (metacarpophalangeal and interphalangeal joints), but may also affect different locations, such as feet. Compared to rheumatoid arthritis, patients present with much more attenuated pain and stiffness, and may even be asymptomatic 2

Etiology is unknown, but thought to be related to manual labor.

General appearance is typical of rheumatoid arthritis:

  • bilateral
  • symmetric
  • marginal erosions
  • ulnar deviation of metacarpophalangeal joints
  • synovial proliferation

Notable differences between the robust form and typical rheumatoid arthritis:

Also known as arthritis robust or rheumatoid robustus, this entity was first described by WHD de Haas et al. in 1973 3.

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