Jeevan Prakash
Department of Medicine, Era’s Lucknow Medical College & Hospital, Lucknow.
Corresponding Author: Dr. Jeevan Prakash, 41-42, Qaiserbagh, Lucknow - 226 001,
E mail: j1prakash@yahoo.co.in
A forty five year old female presented to the medical out patient department with complaints of pain and swelling of small joints of hands and wrist along with early morning stiffness for the past 6 months. A radiograph of her hands was taken and other blood tests were performed.
What is the diagnosis?
X-ray of bilateral hands showing peri-articular osteoporosis, a characteristic feature of Rheumatoid arthritis. The small arrow head shows bony erosion.
Key messages-
- Periarticular osteopenia in appendicular bones occurs early in the course of rheumatoid arthritis and is one of the earliest radiological signs of rheumatoid arthritis
- Bilateral symmetrical, hand joint involvement, small joints involvement, with early morning stiffness, positive Rheumatoid factor and supportive radiological evidence are the characteristic features of Rheumatoid arthritis.
- Rheumatoid arthritis is associated with both generalised osteoporosis as well as localised peri-articular osteoporosis. Osteoporosis in Rheumatoid arthritis results from increase in bone resorption. However, use of glucocorticoids for treatment also results in decreased bone formation. Disease activity, immobility, corticosteroid use and menopausal status are important determinants of osteoporosis in rheumatoid arthritis.
- Localised peri-articular osteoporosis can also be observed in cases of other inflammatory joint disease, but then it is not symmetrical and characteristically will not involve the small joints of the hand as in this case of Rheumatoid arthritis.
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