Arthritis mutilans is a rare medical condition involving severe inflammation damaging the joints of the hands and feet, and resulting in deformation and problems by moving the affected area; it can also affect the spine. As an unusual artropathy, mutilans arthritis is initially described as affecting the hands, feet, fingers, and/or legs, but can refer to severe damage in general to joints damaged by arthropathy. First described in modern medical literature by Marie and Leri in 1913, at hand, arthritis mutilans is also known as the glass hand opera ( la main en lorgnette in French), or chronic absorption arthritis . Sometimes there is foot involvement in which the toes shorten and where the calluses develop in a condition known as the operatic glass leg, or pied en lorgnette .
Video Arthritis mutilans
Signs and symptoms
For someone with arthritis mutilans at hand, the fingers become shortened by arthritis, and shortening can become quite severe so the hand looks like a leg, with the first deformity occurring in the interphalangeal and metacarpophalangeal joints. The excess skin from the shortening of the phalanx bones to be folded across, as if drawn into each other like operatic glasses, hence the description of la main en lorgnette . As the condition worsens, the slowness, phalangeal and metacarpal bone absorbers, and loss of skeletal architecture in the radius occur.
Maps Arthritis mutilans
Cause
Arthritis mutilans occur mainly in people who have psoriatic arthritis that already exists, but can occur, if more rarely, in advanced rheumatoid arthritis; it can also happen independently. Psoriasis and psoriatic arthritis are diseases associated with disorders, occurring with greater frequency of heresy than rheumatoid arthritis, primary Sjo¨gren's syndrome and thyroid disease. Psoriasis affects 2-3% of the Caucasian population, and psoriatic arthritis affects up to 30% of them. Arthritis mutilans presents about 5-16% of cases of psoriatic arthritis, involving osteolysis of the DIP and PIP joints, and may include bone edema, bone erosion, and new bone growth. Most often psoriatic arthitis is seronegative for rheumatoid factor (occurs in only about 13% of cases), and has genetic risk factors overlap with ankylosing spondylitis with HLA-B27, IL-23R77, and IL-1; however, by 2016, immunopathogenesis clear.
Diagnosis
Enthesitis may be helpful in distinguishing arthritis psychiatrist arthritis mutilans' parents from rheumatoid arthritis and osteoarthritis, with evidence in plain radiographs (x-rays) and MRI as periostitis, new bone formation, and bone erosion. Ductillitis, spondylitis and sacroiliitis are common in psoriatic arthritis in the elderly, but not in rheumatoid arthritis. MRI bone edema scores are high in mutilans arthritis and correlate with radiographic measurements of joint damage, although they may not correlate with disease activity. Significant pain sources, bone marrow edema (or lesions, using newer terminology), may be detected on MRI or by ultrasonography by an excessive water signal in the bone marrow. In particular, bone marrow edema can be detected in bone in T1-weighted images as a less obvious area of ​​low signals, with a high signal in T2-weighted fat-pressured images. Comparatively, with arthritis mutilans in rheumatoid arthritis, bone marrow edema often involves the subchondral bone layer, whereas the condition as a subtype of psoriatic arthritis includes a greater degree of marrow edema, to the diaphysis.
Treatment
Medication
Bone edema in mutilans arthitis may be treated with TNF inhibitors in the short term: a 2007 study found that bone edema associated with psoriatic arthritis (where mutilans artitis is a subtype) responded to TNF inhibitors with "dramatic" improvement, but the study did not determine whether TNF inhibitors will prevent new bone formation, bone fusion, or osteolysis (bone resorption).
Surgery
Although a 2011 research article states that disputes between hand surgeons and rheumatologists remain about the indication, timing and effectiveness of rheumatoid hand surgery, mutilance arthritis may be successfully treated with iliac-bone grafts and arthrodesis of the interphalangeal joints and metacarpophalangeal joints in each finger.
Results
The condition of arthritis arthritis mutilans' psoriatic arthritis leaves people with a 60% higher risk of death than the general population, with early deaths causing reflects those of the general population, the most common cardiovascular problems. Life expectancy for people with psoriatic arthritis is estimated to be reduced by about 3 years.
References
External links
Source of the article : Wikipedia
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