Clinical features
Signs
The main clinical findings are swelling of the knuckle joints, wrists and the joints of the ball of the foot. In more advanced disease deviation of the fingers with deformities, together with partial dislocation of the wrists and tendon ruptures tend to occur causing “dropped fingers”. There is often muscle wasting around affected joints.
Similar changes occur in the feet and ankles. In severe disease the knees, hips and neck may also be affected.
Symptoms
The main symptoms of RA are swollen, painful and stiff hands and feet especially in the morning.
In early Disease
Swelling of the knuckle joints (metacarpo-phalangeal [MCP]) joints, wrists and the joints of the ball of the foot (metatarso-phalangeal ([MTP]) joints.
Thickening of the joint lining (synovium) causing swelling.
In established disease
- Deviation of fingers with deformities
- Subluxation (partial dislocation) of wrists – the Piano Key deformity
- Rupture of wrist tendons causing “dropped fingers”
- Muscle wasting around the affected joints
- Similar changes occur in the feet and ankles as above
- In advanced RA, the knees, hips and neck may also be affected.
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