Looking at and Touching Joints in Rheumatoid Arthritis

Mrs. A. R. is 52 years old and is suffering from rheumatoid arthritis since 1994. Last rheumatoid factor has been measured at 392 IU/ml; CRP has been 3.5 mg/l. At the last consultation two joints still were swollen. DAS28 = 3.64, RADAI 4.0. She has been receiving 40 mg adalimumab s.c. every two weeks since 2003. X-ray charts of hands and feet showed erosive disease, which hasn’t progressed in recent years.

This is a photograph of the actual rheumatologic examination. The joints with circles are synovialitically swollen in the palpatory examination.

If you look at the photograph of the hands, you might get the impression that also the MCP-3 joint of the left hand and the MCP-5 joint of the right hand are synovialitically swollen. Actually these swellings are due to post arthritic osteoarthritis, which aren’t activated, but might show acceleration in the future, which isn’t due to inflammation.



The X-ray chart shows erosive disease.

All in all in rheumatoid arthritis you need to look at joints, feel the joints, and use X-ray (or another equal method) to evaluate, where the disease stands. Relying on one method only might under- or overestimate disease activity and lead to wrong therapeutic decisions. So, a quick look isn’t giving the best of care.

Related blogpost: http://rheumatologe.blogspot.de/2012/06/malingerer-with-erosive-rheumatoid.html