Introduction
Arthritis mutilans also known as "opera glass hand" or "telescoping finger" is a rarely seen and a severe form of psoriatic arthritis. It affects about five percent of people with psoriatic arthritis. This condition causes progressive destruction of the bones and results in severe bone loss, problems related to movements, and joint deformation. It is typically seen in the toes, wrists, and fingers. This occurs due to severe joint and bone damage that causes the fingers to collapse and resembles the opening of opera glasses or a telescope. The bones dissolve, and the soft tissues cannot support the fingers, resulting in a telescoping appearance.
What Is Arthritis Mutilans?
Arthritis mutilans are also called pencil-in-cup deformity because of their peculiar radiographic appearance. It is characterized by the destruction of the joints and bones, leading to deformities and a significant functional impairment. This condition can develop alone but is also seen in individuals with psoriatic arthritis or rheumatoid arthritis. However, the rate of developing this condition in rheumatoid arthritis patients is lower than that of psoriatic arthritis patients.
Rheumatoid arthritis and psoriatic arthritis are long-lasting autoimmune diseases that cause inflammation and pain in the joints, leading to damage and deformity. Disability caused by both these conditions impacts the quality of life.
What Are the Causes of Arthritis Mutilans?
The exact cause of arthritis mutilans is not fully understood, but it is believed to be associated with certain factors, which includes
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Autoimmune Disorders: Disorders like psoriatic arthritis and rheumatoid arthritis are long-lasting autoimmune diseases that affect the skin and joints.
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Psoriatic Arthritis affects some individuals with psoriasis, a skin condition characterized by red, scaly patches. It is a complex disease found in various body parts, including the skin, joints, and nails.
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Rheumatoid Arthritis is a type of arthritis that causes inflammation and pain in the joints, leading to damage and deformity.
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Genetic Factors: Genetic mutations affect the cartilage and bone. Psoriatic arthritis patients with the HLA-B27 gene have a higher chance of developing this condition.
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Joint Injury Due to Trauma: Injuries at psoriatic arthritis or rheumatoid arthritis site can develop arthritis mutilans.
What Are the Symptoms of Arthritis Mutilans?
The symptoms of arthritis mutilans include:
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Pain: The affected joints may be painful, especially during movements and physical activity.
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Wearing Out of Joints and Bones: It is seen in hands and feet. These changes occur due to inflammation over the affected area.
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Joint Disability: Difficulty in moving, bending, or straightening the joints.
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Swelling: The joints may become swollen and tender due to inflammation.
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Stiffness Due to Bone Fusion: Ankylosis or fusion of bones within the joint creates stiffness and results in limited mobility. The affected joints may feel stiff, especially after periods of inactivity.
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Deformities: The shape of fingers and toes may become distorted and appear twisted.
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Restricted Joint Mobility: Joint mobility can become severely limited, making daily activities such as writing, typing, or even walking difficult.
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Skin Changes: The affected joints will become shorter, forming loose skin in those areas. The skin over the affected joints may appear tight, wrinkled, and shiny.
How Can Arthritis Mutilans Be Diagnosed?
Arthritis mutilans can be diagnosed with the help of the following steps.
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Physical Examination: A doctor will examine the affected joints for signs of pain, swelling, and deformities.
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Imaging Tests: X-rays or other imaging tests, such as MRI (magnetic resonance imaging) scan or CT (computed tomography) scan, may be used to confirm the diagnosis of arthritis mutilans and assess the extent of joint destruction and bone resorption.
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Blood Tests: Blood tests may be used to check for underlying autoimmune disorders, such as rheumatoid arthritis, or to rule out other conditions that may cause similar symptoms. The blood tests are listed below:
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Rheumatoid Factor (RF) Test: A test that measures the presence of rheumatoid factor, an antibody commonly found in people with rheumatoid arthritis. High levels of RF indicates an autoimmune disorder , but it can also be present in other conditions.
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Anti-Cyclic Citrullinated Peptide (anti-CCP) Test: A test that measures the presence of antibodies against cyclic citrullinated peptides, which are proteins found in the joint. A positive anti-CCP test is highly specific for rheumatoid arthritis.
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Erythrocyte Sedimentation Rate (ESR) Test: A test that measures the rate at which red blood cells settle to the bottom of a test tube. An elevated ESR can indicate inflammation, which is a common symptom of arthritis.
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C-Reactive Protein (CRP) Test: A test that measures the level of CRP, a protein produced in response to inflammation. An elevated CRP level can indicate inflammation in the body, which may be associated with arthritis.
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Sometimes, a biopsy of the affected joint may be performed to confirm the diagnosis and to assess the type and severity of joint damage.
What Is the Treatment for Arthritis Mutilans?
Treatment for arthritis mutilans mainly involves a combination of medications and therapies to control pain and inflammation, slow the progression of joint damage, and restore joint function and mobility. The treatment options for arthritis mutilans include the following.
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Medications: NSAIDs (nonsteroidal anti-inflammatory drugs), and DMARDs (disease-modifying antirheumatic drugs), such as Methotrexate, may be prescribed to reduce pain and inflammation and slow the progression of joint damage. TNF (tumor necrosis factor) inhibitors like Etanercept can be used to treat psoriatic arthritis.
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Physical Therapy: Physical exercises can improve joint mobility and function and help the patient maintain their independence and quality of life.
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Assistive Devices: Braces, splints, canes, or other assistive devices may be recommended to help support the affected joints and reduce the risk of injury.
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Joint Injections: Corticosteroid injections into the affected joints may be recommended to provide temporary relief from pain and inflammation.
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Joint Surgery: Surgery like joint fusion may be performed to correct deformities and to improve function. Surgery to replace damaged joints with artificial joints is usually done in severe cases.
Conclusion
Arthritis mutilans is a rarely seen form of arthritis. Early diagnosis and proper treatment can slow the progression of joint damage and improve symptoms. Working closely with a rheumatologist or other specialist is important to develop an appropriate treatment plan for patients with this condition. In addition, a healthy lifestyle, including a balanced diet, regular exercise, and stress management techniques, may also help to improve overall health and reduce the symptoms of arthritis mutilans to a certain extent.
