Arthritis mutilans

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Arthritis mutilans
X-ray of a hand affected by arthritis mutilans
Synonyms	Mutilating rheumatoid arthritis, Psoriatic arthritis mutilans
Pronounce	N/A
Specialty	N/A
Symptoms	Severe joint deformity, bone resorption, joint pain
Complications	Joint destruction, disability
Onset	Typically between ages 20 and 50
Duration	Chronic
Types	N/A
Causes	Autoimmune disease, genetic factors
Risks	Family history, psoriasis, rheumatoid arthritis
Diagnosis	Clinical examination, X-ray, MRI
Differential diagnosis	Rheumatoid arthritis, Psoriatic arthritis, Osteoarthritis
Prevention	N/A
Treatment	Disease-modifying antirheumatic drugs (DMARDs), biologics, physical therapy
Medication	Methotrexate, TNF inhibitors, NSAIDs
Prognosis	N/A
Frequency	Rare
Deaths	Rarely directly fatal, but can lead to severe disability

Arthritis mutilans is a rare medical condition involving severe inflammation damaging the joints of the hands and feet, and resulting in deformation and problems with moving the affected areas; it can also affect the spine.

Psoriatic arthritis digit

Signs and symptoms

Signs and symptoms of psoriatic arthritis include:

• stiff, painful joints with redness, heat, and swelling in the surrounding tissues.
• When the hands and feet are affected, swelling and redness may result in a "sausage-like" appearance of the fingers or toes called dactylitis.
• Psoriatic arthritis usually occurs between the ages of 30 and 50.
• In some patients, psoriatic arthritis develops in the absence of noticeable skin changes.

Rheumatoid arthritis hands

Cause

Arthritis mutilans occurs mainly in people who have pre-existing psoriatic arthritis, but can occur, if less often, in advanced rheumatoid arthritis; it can also occur independently

Diagnosis

Enthesitis can assist in differentiating arthritis mutilans' parent condition psoriatic arthritis from rheumatoid arthritis and osteoarthritis, with evidence in plain radiographs (x-rays) and MRI as periostitis, new bone formation, and bone erosions.

Treatment

Treat the underlying cause

Medication

The bone edema in arthritis mutilans can be treated with TNF inhibitors

Surgical

Although a 2011 research article stated that disagreements between hand surgeons and rheumatologists remain regarding the indications, timing and effectiveness of rheumatoid hand surgery

Outcomes

Arthritis mutilans' parent condition psoriatic arthritis leaves people with a mortality risk 60% higher than the general population, with premature death causes mirroring those of the general population, cardiovascular issues being most common.