What is the characteristic distribution of rheumatoid arthritis (RA) in the hands on radiographs?

Updated: Mar 28, 2019
  • Author: Ian Y Y Tsou, MBBS, FRCR; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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The hands are affected symmetrically, and the disease process is usually visible first at the second and third MCP joints and the third PIP joint. The disease continues in the remainder of the MCP and PIP joints. Varying stages may be seen in different joints at a single point in time. DIP joint involvement without proximal involvement is rare.

Erosions may be detected first either in the MCP and PIP joints or at the carpal bones. Erosions may also be seen at the intra-articular portion of the distal end of the radius or within the carpal bones. Carpal bone ankylosis is a common and fairly specific sign, particularly in the Asian population, in whom it tends to occur early in the disease process.

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