Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

 

Arthritis of the Fingers

Introduction

• Arthritis commonly affects finger and hand joints
• Diagnosis may be challenging due to overlapping clinical features
• Pattern of joint involvement is key to differentiation

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Common Types of Finger Arthritis

• Osteoarthritis
• Psoriatic arthritis
• Gouty arthritis
• Rheumatoid arthritis

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1. Osteoarthritis of the Fingers

Overview

• Degenerative joint disease
• Features:
  • Cartilage degeneration
  • Osteophyte formation
• Common in middle-aged and elderly

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Heberden’s Nodes

• Location:
  • Distal interphalangeal (DIP) joints
• Cause:
  • Osteophyte formation
• Features:
  • Initially painful
  • Later painless but prominent

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Bouchard’s Nodes

• Location:
  • Proximal interphalangeal (PIP) joints
• Features:
  • Joint stiffness
  • Reduced mobility
  • May be painful or painless

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Digital Mucous (Myxoid) Cysts

• Location:
  • Near DIP joint
  • Base of fingernail
• Association:
  • Underlying osteoarthritis

Treatment

• Surgical excision
• Removal of osteophyte (reduces recurrence)

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2. Psoriatic Arthritis

Overview

• Chronic inflammatory arthritis
• Associated with psoriasis
• Can mimic OA or RA

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Key Clinical Features

Dactylitis (Sausage Digit)

• Diffuse swelling of entire digit
• Due to:
  • Synovitis
  • Tenosynovitis
  • Soft tissue inflammation

Nail Changes

• Nail pitting
• Associated with cutaneous psoriasis

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3. Gouty Arthritis of the Fingers

Overview

• Caused by monosodium urate crystal deposition
• Associated with hyperuricemia

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Clinical Features

• Sudden onset:
  • Severe pain
  • Swelling
  • Tenderness
• May mimic infection

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Pathophysiology

• Needle-shaped urate crystals
• Causes:
  • Acute inflammation
  • Synovitis
  • Tenosynovitis

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Radiological Findings

• Periarticular erosions
• Features:
  • Well-defined
  • Sclerotic margins
  • Overhanging edges (classic)

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4. Rheumatoid Arthritis (RA) of the Hand

Overview

• Chronic systemic autoimmune disease
• Affects:
  • Synovium
  • Tendons
  • Ligaments

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Epidemiology

• More common in females
• Typically:
  • Polyarticular
  • Bilateral
  • Symmetrical

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Commonly Affected Joints

• MCP joints
• PIP joints
• Wrist joints
• DIP joints usually spared

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Clinical Features

• Joint pain and swelling
• Morning stiffness >30–60 minutes
• Progressive functional loss

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Radiological Findings

• Periarticular osteopenia
• Marginal erosions
• Joint space narrowing
• Minimal osteophytes

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Stages of Rheumatoid Arthritis

Early Stage

• Synovitis
• MCP and wrist swelling
• Flexor tenosynovitis

Associated Features

• Digital vasculitis
• Skin atrophy
• Rheumatoid nodules

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Advanced Stage

• Structural joint damage

Clinical Findings

• Ulnar deviation
• MCP swelling
• Extensor tendon displacement
• Tendon rupture

Radiological Findings

• Joint destruction
• Subluxation
• Wrist collapse

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Finger Deformities in RA

Swan Neck Deformity

• PIP hyperextension
• DIP flexion

Boutonnière Deformity

• PIP flexion
• DIP hyperextension

Mallet Finger

• DIP flexion
• Due to extensor tendon injury

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Distal Radioulnar Joint (DRUJ) Involvement

• RA may involve DRUJ
• Leads to:
  • Extensor tendon rupture
  • Especially extensor digitorum communis

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Juvenile Idiopathic Arthritis (JIA)

Polyarticular JIA

• >/=5 joints
• ~30% cases

Important Point

• Assess for cervical spine instability

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Oligoarticular JIA

• <5 joints
• ~50% cases

Important Association

• Chronic uveitis (iridocyclitis)

Recommendation

• Regular ophthalmologic screening

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Key Summary Points

• Finger arthritis may be:
  • Degenerative
  • Inflammatory
  • Metabolic

Key Differentiators

• Joint distribution
• Radiological features
• Systemic involvement

Common Conditions

• Osteoarthritis
• Psoriatic arthritis
• Gout
• Rheumatoid arthritis