Presentation
Chronic bilateral, wrist, hand and knee pain. Ongoing treatment for a known clinical condition.
Patient Data
Features suggestive of rheumatoid arthritis (RA) as evidenced by the symmetric findings of :
periarticular osteopenia especially centered at the MCP and PIP articulations
Hitchhiker's thumb (right greater than left)
carpal degenerative changes (including radial and ulna styloid erosions)
Important negative findings:
absence of subluxations, dislocations or ulna deviation
absence Boutonniere or swan-neck deformities
absence of telescoping
Features suggestive of secondary osteoarthritis with a background of rheumatoid arthritis:
tri compartmental joint space narrowing on the left
bi-compartmental joint space narrowing on the right
minimal osteophytes
minimal subchondral cysts
bilateral supra-patellar effusion
Case Discussion
The patient has known rheumatoid arthritis on treatment. The hand findings are typical of the known diagnosis.
The presence of tri-compartmental secondary osteoarthritis of the knees (in this instance, predominantly the left knee) also alludes to the known diagnosis because of the non-weight-bearing lateral compartmental involvement typical in rheumatoid arthritis. The lack of marginal and often exuberant osteophytes and subchondral cyst formation given the significant joint space reduction that is present, is also another finding suggesting RA.
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