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Table of Contents
LETTER TO THE EDITOR
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 107-108

Is it rheumatoid arthritis or something else?


Department of Neurology, Dr. RML Hospital, Delhi, India

Date of Submission01-Apr-2020
Date of Decision21-Apr-2020
Date of Acceptance24-May-2020
Date of Web Publication07-Jul-2020

Correspondence Address:
Dr. Abhishek Juneja
A-15, Old Quarters, Ramesh Nagar, New Delhi - 110 015
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_21_20

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How to cite this article:
Juneja A, Anand KS, Ali I. Is it rheumatoid arthritis or something else?. Indian J Med Spec 2020;11:107-8

How to cite this URL:
Juneja A, Anand KS, Ali I. Is it rheumatoid arthritis or something else?. Indian J Med Spec [serial online] 2020 [cited 2020 Aug 13];11:107-8. Available from: http://www.ijms.in/text.asp?2020/11/2/107/289117



Dear Editor,

A 74-year-old woman presented with progressive deformities of the left hand and foot for 2 years. She did not complain of any pain in the small joints of hands or feet. She was diagnosed of idiopathic Parkinson's disease (PD) 4 years back based on her clinical symptoms including rest tremors, bradykinesia, and rigidity. There was no other comorbid illness in the past. On physical examination of the left hand, there was flexion of metacarpophalangeal joints, hyperextension of proximal interphalangeal joints, and flexion of distal interphalangeal joints [Figure 1], while in the left foot, there was extension of the great toe with flexion of other toes [Figure 2]. There was no redness, swelling, or tenderness in any of the joints. Her routine blood investigations including inflammatory markers and rheumatoid factor were normal. Anticyclic citrullinated peptide antibodies were also within normal range.
Figure 1: Striatal hand in a patient with Parkinson's disease

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Figure 2: Striatal foot in a patient with Parkinson's disease

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Striatal deformities of the hand and foot are painless, fixed contractures of the distal joints. They are associated with pathology in the neostriatum, a combination of putamen and caudate.[1] The terms “striatal hand” and “striatal foot” were originally used by Charcot and Purves-Stewart to report the distal limb deformities typically associated with PD.[2],[3] Striatal deformities have been reported in 10% of patients with advanced PD.[1] These deformities are quite specific of PD. They are often worse on the side of disease onset.

Striatal limb deformities resemble dystonic postures that are common in Parkinsonian disorders.[1] Dystonic postures are dynamic in contrast to fixed striatal deformities. These deformities are commonly misdiagnosed as rheumatoid arthritis and hence sometimes also called pseudorheumatoid deformities. Other common misdiagnoses include Dupuytren's contractures, de Quervain's tenosynovitis, and Babinski sign. Response to treatment with antiparkinsonian drugs is not predictable as far as the deformities are concerned. Botulinum toxin and surgery are other options for such deformities.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jankovic J, Tintner R. Dystonia and parkinsonism. Parkinsonism Relat Disord 2001;8:109-21.  Back to cited text no. 1
    
2.
Charcot JM. Lectures on the Diseases of the Nervous System, Lecture V. London: New Sydenham Society; 1877. p. 140-47.  Back to cited text no. 2
    
3.
Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson A, Jónsson T. Epidemiology of Dupuytren's disease: clinical, serological, and social assessment–the Reykjavik study. J Clin Epidemiol 2000;53:291-6.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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