Fast Facts by John D Isaacs; Larry W Moreland

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By John D Isaacs; Larry W Moreland

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C) The (c) feet demonstrate swelling and valgus deformities at the ankles, flattening of the longitudinal arches with pes planus, and early clawing of the toes.  In the hands, the swan-neck, boutonnière and z thumb deformities represent tendon slippage with an altered axis of traction that compromises joint motion. Subluxation and ulnar deviation at the MCP joints, and subluxation at the wrist are also characteristic features of established RA. Flexor tenosynovitis is additionally associated with ‘triggering’ (locking or ‘catching’) of the fingers.

7). More sinister is the involvement of medium-sized arteries, leading to digital gangrene. 6 A hand displaying the small vasculitic infarcts (and swan neck deformities of the fingers) associated with rheumatoid arthritis. 7 A vasculitic leg ulcer in a patient with rheumatoid arthritis. The ulcer has punched-out edges and a necrotic base. possible, including the mesenteric, coronary or cerebral vessels, although renal involvement is rare. Osteoporosis is a common and underdiagnosed complication of RA.

In the feet, the subtalar joint and talonavicular joint are more commonly affected than the ankle joint itself. A valgus deformity at the subtalar joint and associated ligamentous laxity results in flattening of the longitudinal arch and pes planus. Disease of the MTP joints and associated tendons results in splaying and clawing of the toes, followed by subluxation. Consequent pressure on the metatarsal heads during walking results in the characteristic symptom of ‘walking on pebbles’. When examining the feet, inspection of the plantar surface may reveal calluses, under the metatarsal heads and at other sites, suggesting impaired foot mechanics.

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