Rheumatoid arthritis – hand

Rheumatoid arthritis typically involves the wrists and MCP joints, in a bilateral symmetrical pattern. It may involve the proximal interphalangeal joints, but never involves the distal interphalangeal joints. This patient’s right hand illustrates this nicely – despite severe, destructive changes in the wrists, MCP and PIP joints, the DIP joints are completely normal. If you see what looks like rheumatoid arthritis on a hand or foot x-ray, but the DIP joints are involved, you should think of psoriatic arthritis instead.