All are seen in Rheumatoid arthritis EXCEPT:
Correct Answer: Heberden nodes
Description: Ans. (b) Heberden's nodesRef: Harrison 18th ed. / ch. 332*"Heberderis nodes are hard or bony swellings that develop in the distal interphalangeal joints (DIP) in a case of osteoarthritis"Clinical Features of Rheumatoid Arthritis*The presenting symptoms of RA typically result from inflammation of the joints, tendons, and bursae.*Early morning joint stiffness lasting more than 1 hour and easing with physical activity. *The earliest involved joints are typically the small joints of the hands and feet. The initial pattern of joint involvement may be monoarticular, oligoarticular(<4 joints), or polyarticular (>5 joints), usually in a symmetric distribution* Wrists, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints stand out as the most frequently involved joints.* The frequent hallmark of RA: Flexor tendon tenosynovitis.Deformities* Ulnar deviation of the hand.* Swan-neck deformity: Hyperextension of the PIP joint with flexion of the DIP* Boutonniere deformity: Flexion of the PIP joint with hyperextension of the DIP joint* Z-line deformity Subluxation of the first MCP joint with hyperextension of the first interphalangeal (IP) joint* Inflammation about the ulnar styloid and tenosynovitis of the extensor carpi ulnaris may cause subluxation of the distal ulna, resulting in a "piano-key movement" of the ulnar styloid* Metatarsophalangeal joint (MTP) involvement is a feature of early disease in the feet* Atlantoaxial involvement of the cervical spine can cause compressive myelopathy and neurologic dysfunction* Most frequent extraarticular manifestations: Subcutaneous nodules, secondary Sjogren's syndrome, pulmonary nodules, and anemia.
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