Question
The presence of 'swan-neck' deformity, 'buttonhole' deformity, 'Z' deformity of the thumb and 'Baker's cysts' suggest which of the following?
The correct answer is
Rheumatoid arthritis
Rheumatoid Arthritis Diagnosis: Key Clinical Signs
The presence of specific deformities in the hands and the development of Baker's cysts are highly suggestive of Rheumatoid Arthritis (RA).
Recognizing Rheumatoid Arthritis Manifestations
- Swan-neck deformity: Characterized by hyperextension of the distal interphalangeal (DIP) joint and flexion of the proximal interphalangeal (PIP) joint. This is a common consequence of inflammation and laxity in RA.
- Buttonhole deformity (Boutonnière deformity): Involves flexion of the PIP joint and hyperextension of the DIP joint, caused by damage to the central slip of the extensor tendon.
- 'Z' deformity of the thumb: This deformity results from instability at the carpometacarpal (CMC) and metacarpophalangeal (MCP) joints, causing flexion at the MCP and thumb adduction.
- Baker's cysts: These are fluid-filled sacs that develop at the back of the knee (popliteal fossa). They are a common extra-articular manifestation of RA due to increased synovial fluid production in the knee joint.
While other conditions like Reiter's syndrome, gouty arthritis, and psoriatic arthritis cause joint inflammation, the specific combination of 'swan-neck' deformity, 'buttonhole' deformity, 'Z' deformity of the thumb, and Baker's cysts is most characteristic of Rheumatoid Arthritis.
Conclusion
Based on the characteristic clinical signs presented, the condition is Rheumatoid Arthritis.
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Important Questions from Arthritis
- Which of the following statements regarding Ankylosing spondylitis (AS) are true?
1. AS occurs in about 10 % of Inflammatory Bowel Disease(IBD) patients
2. The AS activity is related to Bowel activity in IBD patients
3. The AS activity does remit with glucocorticoids or colectomy in IBD patients
Select the correct answer using the code given below: - Which of the following statements about “Early onset Osteoarthritis” are true?
1. Onset is usually before the age of 55 years
2. There is clear history of previous trauma
3. In most cases, single joint is affected
Select the correct answer using the code given below: - A 31-year young man presents with fever, weight loss, pain with swelling of knee joint and low backache with stiffness. Three weeks earlier, he was treated for symptoms of urinary tract infection by local practitioner. The joint aspirate is leucocyte rich and contains multinucleated macrophages. His urine culture is sterile. What is the most probable diagnosis?
- Consider the following statements regarding Gout in old age.
1. Most of older patients have gout secondary to diuretic use and chronic kidney disease
2. Joints of the upper limbs are more frequently affected
3. Presentation is typical with acute attack of gout
Which of the statements given above are correct? - A 28-year old woman complains of arthritis involving bilateral metacarpophalangeal, proximal interphalangeal and wrist joints of one year duration. The most likely disease entity is:
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