From the Guidelines
Arthritis mutilans is characterized by severe deformities, including telescoping digits, marked shortening of digits, and excessive mobility of affected joints, resulting in a "main en lorgnette" (opera-glass hand) appearance. The physical exam findings of arthritis mutilans include severe deformities, with the fingers being shortened and pulled out like a telescope due to extensive bone resorption, as noted in the context of psoriatic arthritis 1. Key features of arthritis mutilans on physical examination are:
- Telescoping digits (also called opera-glass fingers)
- Marked shortening of digits
- Excessive mobility of affected joints
- Flail joints with hypermobility due to destruction of articular surfaces and supporting structures
- Soft tissue swelling and joint tenderness
- Significant loss of function
- Skin over affected joints may appear loose and redundant due to underlying bone loss
- Difficulty with fine motor tasks and compensatory movements. The destructive changes in arthritis mutilans result from persistent inflammation causing osteolysis (bone resorption) that exceeds new bone formation, as seen in the context of psoriatic arthritis and other rheumatic diseases 1.
From the Research
Physical Exam Findings of Arthritis Mutilans
The physical exam findings of arthritis mutilans include:
- Digital shortening associated with severe osteolysis of peripheral joints 2
- Severe resorptive bone destruction and joint instability 3
- Pencil-in-cup deformities and gross osteolysis in any joint 4
- Mutilans-like hand deformities, which can be evaluated using the Larsen hand score and the mutilans hand score 5
- Spontaneous fusions in the peripheral joints 5
- Pseudoarthroplastic hand, a radiological finding suggestive of previous surgery 6
Characteristics of Arthritis Mutilans
Characteristics of arthritis mutilans include: