Arthritis mutilans

Arthritis mutilans

Arthritis mutilans, is a rare arthropathy originally described as affecting the hands, feet, fingers, and/or toes, but refers in general to severe derangement of any joint.[1] In the hands, it is also known as opera glass hand (la main en lorgnette), or chronic absorptive arthritis, first described in modern medical literature by Marie and Leri in 1913.[2][3] Sometimes there is foot involvement in which toes shorten and on which painful calluses develop in a condition known as opera glass foot, or pied en lorgnette.[4][5]

Etiology

Arthritis mutilans occurs mainly in patients with psoriatic arthritis and rarely advanced rheumatoid arthritis, but can occur independently.[4][5]

Symptoms

In arthritis mutilans, a patient's fingers become shortened by arthritis, and the shortening may become severe enough that the hand looks paw-like, with the first deformity occurring at the interphalangeal and metacarpophalangeal joints. The excess skin from the shortening of the phalanx bones becomes folded transversely, as if retracted into one another like opera glasses, hence the description la main en lorgnette. As the condition worsens, luxation, phalangeal and metacarpal bone absorption, and skeletal architecture loss in the fingers occurs.[4] MRI bone edema scores are high in arthritis mutilans and correlate with radiographic measures of joint damage, although they may not correlate with disease activity.[6]

Treatment

Although a 2011 research article stated that disagreements between hand surgeons and rheumatologists remain regarding the indications, timing and effectiveness of rheumatoid hand surgery,[7] arthritis mutilans may be successfully treated by iliac-bone graft and arthrodesis of the interphalangeal joints and the metacarpophalangeal joint in each finger.[8][4]

References

  1. ↑ Nielsen, Børge, and Egill Snorrason, Arthritis mutilans, Acta Radiologica [Old Series], November 1946 os-27: 607-616, doi:10.1177/028418514602700605 (doi given by sagepub.com returns a doi error on 2014-4-11; reported.)
  2. ↑ Nelson, L. S., The Opera-Glass Hand in Chronic Arthritis. "La Main en Lorgnette" of Marie and Leri, Journal of Bone and Joint Surgery, 20:1045-1049, 1938-10-1. Accessed 2012-6-7.
  3. ↑ Solomon, W.M., Stecher, R.M., Chronic Absorptive Arthritis or Opera-Glass Hand, Annals of the Rheumatic Diseases: report of 8 cases, September 1950, 9(3):209–220, ncbi.nlm.nih.gov. PMID 14783359. Accessed 2012-6-7.
  4. 1 2 3 4 Froimson, Avrum I., M.D., Hand Reconstruction in Arthritis Mutilans A Case Report, Journal Of Bone and Joint Surgery, 53-A:7, 1971-10-1, pp. 1377-1382. PMID 4939959. Accessed 2012-6-7.
  5. 1 2 Eisenstadt, H. B., and Eggers, G.W.N., Arthritis Mutilans, Journal of Bone and Joint Surgery, 37-A:337-346, April 1955. PMID 14367425. Accessed 2014-4-11.
  6. ↑ Tan Y. M., et al, MRI bone oedema scores are higher in the arthritis mutilans form of psoriatic arthritis and correlate with high radiographic scores for joint damage, Arthritis Research & Therapy, 11(1) 2009. PMID 19126234. Accessed 2015-11-15.
  7. ↑ Chung, Kevin C., and Pushman, Allison G., Current Concepts in the Management of the Rheumatoid Hand, Journal of Hand Surgery, April 2011, 36(4):736–747. PMID 21463736. doi:10.1016/j.jhsa.2011.01.019. Accessed 2014-4-11.
  8. ↑ Nalebuff EA, Garrett J (1976). "Opera-glass hand in rheumatoid arthritis". J Hand Surg Am 1 (3): 210–20. PMID 1018089.
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