In the upper extremity, tophi are usually located in the subcutaneous tissues, more commonly around the elbow and proximal interphalangeal joints
In December 2014, the patient was admitted to the emergency department due to fever that had lasted for three days, associated with arthralgias in proximal interphalangeal joints
and both wrists, discrete malar rash, and pain focused in the region of the left quadriceps, with slight muscle weakness as well as pain at the palpation of the mentioned zone.
The patient also complained of joint pains involving the knee, ankle, wrist and proximal interphalangeal joints
. There was no history of oral ulcers, morning stiffness, ocular symptoms, or contact with infected persons.
His hands and feet appeared short, with middle, painless tumefaction of soft tissue around the index proximal interphalangeal joints
. No spinal abnormalities were noted, but a mild pectus excavatum was present.
proximal interphalangeal joints
bilaterally, tenderness on the wrist joints bilaterally, swan neck deformity on second finger of the right hand, and bilateral ulnar deviation.
The proximal interphalangeal joints
, metacarpophalangeal joints, elbows, and knees are mainly involved in reactional states of leprosy, which are also commonly involved in SLE, adding a further diagnostic dilemma.
There is progressive flexion of the proximal interphalangeal joints
(PIP) with extension of both the metatarsal phalangeal (MTP) and distal interphalangeal joints (DIP).
Patients most commonly popped proximal interphalangeal joints
(15.9%) followed by metacarpal phalangeal joints (13.5%), distal interphalangeal joints (6.1%), and first carpal metacarpal joints (2.3%).
Caption: Figure 2: B-mode high resolution ultrasonography image (longitudinal section) of proximal interphalangeal joints
showing diffuse dermal and subcutaneous oedema (thick lines) and normal joint space with no evidence of synovitis (thin lines).
X-Ray made on lumbar spine, hands, feet and pelvis showed: multiple osteosclerotic oval-round lesions with a maximum diameter of 10 mm, without osteolysis, with a benign character and with a periarticular localization at the level of the fist, metacarpophalangeal joints, proximal interphalangeal joints
, coxofemoral joints, peritarsal, metatarsophalangeal and interphalangeal joints.
In September 2012, a 21-year-old man was admitted to the emergency department of our hospital with complaints of high fever, cough, sore throat, chest pain, polyarthralgia and polyarthritis involving the wrists, knees, ankles, and proximal interphalangeal joints
, and progressive weight loss of 6 kg in 2 months.
Hyperkeratotic plaques mimicking knuckle pads were seen on the proximal interphalangeal joints
. Multiple well defined lichenoid papules were present on the extensor aspects of the elbows and also well-defined plaques were seen on the extensor aspects of the knee joints.