Approximately 40% of JIA patients will experience rear foot (i.e., subtalar) joint synovitis , while the midfoot (talonavicular and calcaneocuboid) and phalangeal joints
appear to be less affected .
On her visit, the consulting surgeon noticed an improperly placed below elbow cast which was well past her metacarpal phalangeal joints
, greatly restricting movement of her left fingers.
Hepatomegaly and bilateral symmetrical polyarthralgia of shoulders, wrists, knees, and phalangeal joints
were also observed.
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%).
She gained improvement in the left hand and wrist, with the return of normal range of motion, skin contour, and wrinkling of the phalangeal joints
. On the original right hand, she remained unable to fully extend the digits, and a right 5th digit contracture remained (see Figure 2).
On radiographs, mild-moderate degenerative joint disease was visible in the right tarsometatarsal and phalangeal joints
. The owner was instructed to flush the wound and change the dressing once daily.
The most common joints affected are the metacarpal phalangeal joints
(MCPs), proximal interphalangeal joints (PIPs), wrists, elbows, knees, mid-foot and the metatarsal phalangeal joints
(MTPs), although this disease can affect any joint in the body except the sacroiliac joints, thoracic spine, and lumbar spine.
A Caucasian male 62 years of age was diagnosed with rheumatoid arthritis in December 2010 after presenting to his physician with symmetrical pain and swelling in both shoulders and metatarsal phalangeal joints
. He was started on methotrexate and titrated to 22.5 mg once a week.
Another useful clue: Psoriatic arthritis often affects the distal phalangeal joints
of the fingers and toes, with accompanying characteristic psoriatic nail changes, but it spares the metacarpophalangeal (MCP) joints.
The deeper prints of trackway 2 preserve greater detail of foot morphology (Fig 3), including footpads that presumably correspond with phalangeal joints
. Digit divarication angle is similar to trackway 1, about 25 degrees.
Tophi were gradually found in bilateral MTP, proximal interphalangeal joint, metacarpal phalangeal joints
, intertarsal joints, and auricles, successively.
Our nonoperative protocol was that patients were splinted or casted in such a way so that the palmar portion of the cast or splint was proximal to the distal palmar crease and that full flexion of the metacarpal phalangeal joints
and inter phalangeal joints
was possible without impediment from the bulk of the cast or splint.