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Arthritis mutilans — Clinical Guidelines

Overview

Arthritis mutilans, also known as acrosyndactyly or mutilating rheumatoid arthritis, is a severe, deforming form of rheumatoid arthritis characterized by progressive joint destruction, resorption of bone, and functional disability, primarily affecting the hands and feet. 9

Diagnosis

Radiographic findings showing characteristic bone resorption and joint deformities.

Clinical presentation with severe joint deformities, functional impairment, and often a history of long-standing rheumatoid arthritis.

No specific laboratory tests; diagnosis is primarily clinical and radiographic. 9

Management

First-line treatments: Early aggressive management of rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDs) such as methotrexate. 4

Adjunctive treatments: Physical therapy focusing on maintaining joint function and preventing contractures. 4

Surgical interventions: Considered for severe deformities to improve function and cosmesis, though specific protocols are not detailed in provided abstracts. 7

Special Populations

Elderly: Management focuses on minimizing functional decline and pain management, with careful consideration of polypharmacy impacts on surgical outcomes. 2

Comorbidities: Patients with comorbidities requiring extensive perioperative care may benefit from enhanced perioperative surgical home models to improve outcomes. 3

Key Recommendations

Early initiation of DMARDs to control rheumatoid arthritis and potentially mitigate progression to arthritis mutilans. (Evidence: Moderate 4)

Implement comprehensive physical therapy programs to preserve joint function and mobility in affected individuals. (Evidence: Expert opinion 4)

For severe cases, multidisciplinary surgical approaches may be considered to address deformities, though evidence is limited and primarily based on expert consensus. (Evidence: Expert opinion 7)

References

1 Peel TN, Astbury S, Cheng AC, Paterson DL, Buising KL, Spelman T et al.. Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty. The New England journal of medicine 2023. link 2 Rasmussen NB, Kehlet H, Knudsen TB, Printzlau P, Jørgensen CC. Preoperative prescriptions and polypharmacy in elective total hip and knee arthroplasty from 2010 to 2017, a descriptive cohort study. Acta anaesthesiologica Scandinavica 2023. link 3 Wyles CC, Abdel MP, Amundson AW, Duncan CM, Pepper MB, Ingalls LA et al.. Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project-Phase II Outcomes. The Journal of arthroplasty 2021. link 4 Jette DU, Hunter SJ, Burkett L, Langham B, Logerstedt DS, Piuzzi NS et al.. Physical Therapist Management of Total Knee Arthroplasty. Physical therapy 2020. link 5 Özkan D, Akkaya T, Yalcindag A, Hanci T, Gönen E, Gümüs H et al.. Propofol sedation in total knee replacement : effects on oxidative stress and ischemia-reperfusion damage. Der Anaesthesist 2013. link 6 Labek G, Stoica CI, Böhler N. Comparison of the information in arthroplasty registers from different countries. The Journal of bone and joint surgery. British volume 2008. link 7 Collins CP, Wilson KJ, Collins PC. Lateral pterygoid myotomy with reattachment to the condylar neck: an adjunct to restore function after total joint reconstruction. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 2003. link 8 Dalén T, Engström KG. Filterability of autotransfusion blood cells and plasma after total knee arthroplasty. Clinical hemorheology and microcirculation 1998. link 9 O'Neill TW, Evison G, Bhalla AK. Pseudoarthroplastic' hand in arthritis mutilans. British journal of rheumatology 1992. link

Arthritis mutilans