ABSTRACT
These elderly women present with complaints of chronic polyarticular arthritis. Musculoskeletal deformities of this disease include all of the following except:
a. Swan-neck deformity of digits b. Boutonnière deformity of digits c. Ulnar deviation of metacarpophalangeal joints d. Heberden’s nodes e. Pes planus
• Rheumatoid arthritis is a systemic inflammatory disease involving the synovial lining of joints
• Most commonly affected joints include the metacarpophalangeal and proximal interphalangeal joints
• Boutonnière deformity is hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint
• Swan-neck deformity is hyperextension of proximal interphalangeal joint and flexion of distal interphalangeal joint
• Involvement usually predominates in small joints and is bilateral
• Patients may complain of prolonged morning stiffness and of symptoms that worsen with repetition
• Complications include cervical spine instability, especially atlantoaxial subluxation. Preoperative radiographs may include cervical spine flexion and extension views
• Treatment options other than physical medicine, nonsteroidal anti-inflammatory drugs, and corticosteroids include use of disease-modifying agents of rheumatic disease:
Methotrexate Hydroxychloroquine Intramuscular injection of gold salts Penicillamine Sulfasalazine Leflunomide Azathioprine Cyclophosphamide
