Presentation
Chronic joint pain and limited range of motion.
Patient Data
There is moderate to severe tricompartmental uniform loss of joint space bilaterally.
There are marginal erosions of the 3rd to 5th metatarsal heads on the left, and 4th and 5th metatarsal heads on the right. There is also a uniform loss of joint space at these locations, as well as at the 2nd metatarsophalangeal joint on the right, and metatarsosesamoid articulations bilaterally.
There is severe uniform lost of joint space at the radiocarpal, ulnocarpal and most of carpometacarpal articulations, with ankylosis of all intercarpal joints and 2nd and 3rd carpometacarpal joints bilaterally.
Interestingly, with this severe pattern of wrist involvement, the metacarpophalangeal joints are spared.
There is minimal uniform lost of joint space on the right with a mild anterior sail sign and minimal elevation of the posterior fat pad, indicating effusion.
Case Discussion
These findings are characteristic of advanced skeletal involvement in rheumatoid arthritis.
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