Also should not have evidence of other disease that may account for symptoms such as polyarteritis nodosa or lupus. Clinical Features Articular movement. Joint destruction occurs with erosion of juxta-articular bone around the margins of pannus and invasion of subchondral tissue by pannus. Can see cysts, loss of cartilage, and bony erosion. Thickened pannus may be palpated around joints with joint effusion present.
Distribution is symmetric, and small joints are predominantly involved.
Manifestations in specific joints. This may lead to atlantoaxial subluxation or, less commonly, subluxation at lower levels. Symptoms are those of a radiculopathy, including pain radiating up into the occiput, paresthesia, sudden deterioration in hand function, sensory loss, abnormal gait, and urinary retention or incontinence. May notice fusiform swelling of fingers and MCP joints, ulnar deviation of fingers, palmar subluxation of proximal area of phalanges. Ulnar deviation at MCP joints often is associated with radial deviation at wrist.