An Overview of Arthritis Mutilans

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Arthritis mutilans (AM) is a very severe type of chronic rheumatoid arthritis (RA) or psoriatic arthritis (PsA). It's characterized by harsh inflammation known for damaging the hands and feet, resulting in deformed joints and loss of use. It may also affect the spine. AM is rare, affecting less than 5 percent of people with PSA and around 4.4 percent of people with RA.

Causes

It is unknown why some people are more susceptible to arthritis mutilans, but researchers do know people with psoriatic arthritis and rheumatoid arthritis are at the highest risk for developing this very destructive form of arthritis.

Rheumatoid arthritis is an autoimmune disease where the body attacks its own immune system because it believes it is being infected by foreign invaders, such as bacteria and viruses. The immune system responds by attacking the joints with inflammation, resulting in swelling and pain in and around the joints. Severe and unchecked inflammation will eventually cause damage to joints.

Psoriatic arthritis, also an autoimmune disease, is a type of inflammatory arthritis affecting people with psoriasis, a skin condition where skin cells generate too quickly and cause skin lesions that appear as red patches with silvery scales. Joint pain, stiffness, and swelling are the main symptoms of PsA and can affect any joint.

When RA and PsA became severe and destructive and start attacking the hands and feet, they are classified as arthritis mutilans. AM will destroy bones and joint cartilage and lead to bone resorption, the breakdown of bone tissue. With AM, there is no bone rebuilding and what is left is soft tissue and bone collapse.

There have been cases of AM reported related to other autoimmune forms of arthritis, including systemic lupus erythematosus, mixed connective tissue disease, and juvenile idiopathic arthritis. However, the research on AM with these conditions is minimal and outdated.

Symptoms

The effects of AM are life-altering. The main symptom of this very serious arthritic condition is harsh bone tissue destruction leading to joint deformity. People with serious bone destruction will struggle to move affected joints and be unable to perform the simple tasks of daily living, such as getting dressed. 

AM may also lead to telescoping fingers and toes, where the soft tissues can no longer hold up the fingers and toes, so they appear in a heap-like fashion. In other instances, bones will fuse together, a condition called ankylosis, causing immobility and abnormal stiffness of the joint. 

Glass Opera Hand

Some people with AM may experience glass opera hand. In this case, the fingers become misshaped due to severe bone destruction and absorption. Additional signs of glass opera hand include:

  • Fingers that significantly shortened or stretched
  • Finger skin that is stretched, shiny looking and wrinkled

Glass opera hand is often a sign of the most advanced and severe cases of RA.

Diagnosis

Diagnosis of AM is usually made by looking for evidence of joint damage with X-rays and magnetic resonance imaging (MRI). Joints are also physically examined to look for visible joint damage. Blood work can measure disease activity and inflammation related to the underlying condition.

Treatment

Early and aggressive treatment for AM is important and should start upon diagnosis. Aggressive physical therapy, especially in the hands, can delay the disease’s progress and halt severe joint damage. That means that people with AM can protect the use of their hands.

Splinting can help with joint stabilization, but it should be done for short periods, as it can lead to muscle weakness.

High doses of non-steroidal anti-inflammatories (NSAIDS) and corticosteroids can help reduce severe inflammation associated with AM. Moreover, research has shown tumor necrosis factor (TNF) inhibitor drugs can be successful in slowing down AM. It should be noted, however, that once joint damage occurs, it is irreversible.

There has been some evidence AM can be repaired with surgery, including iliac bone graft surgery, which can repair damaged joints and bones, and arthrodesis surgery, which can resolve joint fusions.

Coping

AM can be painful and debilitating, but the best ways to cope are with therapy and good self-care. Therapy can include hand therapy, occupational therapy, physical therapy, or a combination of two or more therapies. Good self-care includes a healthy diet, being active, managing stress, and not smoking. Smoking can interfere with the effectiveness of medications and cause AM to progress even quicker, as it may promote inflammation. 

What Makes Arthritis Pain Better and Worse

A Word From Verywell

Arthritis mutilans is one of the most advanced types of joint disease. Once someone is diagnosed with AM, there is no way of knowing the course of the disease. However, medicinal treatment, physical therapy, and a healthy lifestyle can slow down the disease’s progression. And while there is a potential for disability, surgery is a viable option for restoration of joint function. Moreover, there are plenty of people living long lives despite AM’s effects.

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