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What are the hand and wrist deformities in JIA?

Asked by Shilla 

Most common finger deformities in Juvenile Idiopathic Arthritis (JIA) were boutonniere deformity and swan neck deformity. JIA patients can have both radial and ulnar deviation of wrist. The frequency of ulnar deviation is 29-44% across various literatures. 

Reference: Naz, Samia, et al. "Spectrum of Joint Deformities in Children with Juvenile Idiopathic Arthritis." Journal of the College of Physicians and Surgeons Pakistan, vol. 28, no. 6, June 2018, pp. 470.
Radial deviation of MCP joints in association with ulnar deviation of the wrist is recognized in JIA, and Resnick has noted the contrast between this pattern and the opposite finding of ulnar deviation of the MCP joints and radial deviation of the wrist commonly seen in adult onset RA. 

Reference: Imaging of the Hand and Wrist - Techniques and Applications edited by A. Mark Davies, Andrew J. Grainger, Steven J. James

The pattern of involvement is different from that of adult disease. The wrists tend to develop ulnar (rather than radial) deviation, the MCP joints develop flexion contracture (rather than ulnar drift), and the IP joints also become fixed in flexion (swan-neck deformities are rare). The hands are small because of premature fusion of the physis.

Reference: Apley's System of Orthopaedics and Fractures edited by Louis Solomon, David Warwick, Selvadurai Nayagam 

  1. Mohan Prasad28 October, 2022

    What is the mechanism behind this opposite deformity?