Common Forms of Arthritis in the Hands



Acute Rheumatoid Arthritis 

Tender, painful, stiff joints in rheumatoid arthritis, usually with symmetric involvement on both sides of the body. The proximal interphalangeal, metacarpophalangeal, and wrist joints are the most frequently affected. Note the fusiform or spindle-shaped swelling of the proximal interphalangeal joints in acute disease. 



Chronic Rheumatoid Arthritis 

In chronic disease, note the swelling and thickening of the metacarpophalangeal and proximal interphalangeal joints. Range of motion becomes limited, and fingers may deviate toward the ulnar side. The interosseous muscles atrophy. The fingers may show "swan neck" deformities (hyperextension of the proximal interphalangeal joints with fixed flexion of the distal interphalangeal joints). Less common is a boutonniére deformity (persistent flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint). Rheumatoid nodules are seen in the acute or the chronic stage. 



Osteoarthritis (Degenerative Joint Disease) 

Heberden's nodes on the dorsolateral aspects of the distal interphalangeal joints from bony overgrowth of osteoarthritis. Usually hard and painless, they affect the middle-aged or elderly; often associated with arthritic changes in other joints. Flexion and deviation deformities may develop. Bouchard's nodes on the proximal interphalangeal joints are less common. The metacarpophalangeal joints are spared. 



Chronic Tophaceous Gout 

The deformities of long-standing chronic tophaceous gout can mimic rheumatoid arthritis and osteoarthritis. Joint involvement is usually not as symmetric as in rheumatoid arthritis. Acute inflammation may be present. Knobby swellings around the joints ulcerate and discharge white chalk like urates. 



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