Rheumatoid-like deformities in Parkinson’s disease with 1-year follow-up: case report and literature review

Abstract

Rheumatoid-like deformities in joints are uncommon in patients with Parkinson's disease and easy to be misdiagnosed with rheumatoid arthritis. Therefore, unnecessary treatment is often initiated. Here, we report a case of a 60-year-old woman with Parkinson's disease developing a rheumatoid-like joint deformities, and evaluate 1-year follow-up outcome. We also review the literature and discuss the clinical characteristics, possible pathogenesis, and treatment strategy of these cases.

Striatal Hand Deformities in Parkinson's Disease: Hand Surgical Perspectives

“…Finger joints seem to stay unaffected by SHD even in advanced stages 3 and radiographs may not be useful in diagnosing classical SHD, except to exclude other hand surgical diagnoses. In fact, misdiagnoses of SHD are common and can be mistaken for rheumatoid arthritis, Dupuytren's disease or trigger finger 1,3,11 . The latter a sometimes painful condition, where one or more fingers, or the thumb, are locking or catching when flexed or extended, caused by tightness at the A1 pulley of the flexor tendon.…”

“…In fact, misdiagnoses of SHD are common and can be mistaken for rheumatoid arthritis, Dupuytren's disease or trigger finger. 1,3,11 The latter a sometimes painful condition, where one or more fingers, or the thumb, are locking or catching when flexed or extended, caused by tightness at the A1 pulley of the flexor tendon. Two patients in our original cohort had thumb basal joint osteoarthritis, with adduction contracture of the affected joint, leading to a swanneck deformity of the thumb, which could be misinterpreted as a z-thumb.…”

“…SHD may be part of the primary PD process and significantly adds to disability in persons already coping with the complexity of PD symptoms, such as resting tremor, micrography and difficulties in handling objects due to brady−/hypokinesia 1,4,10 . Moreover, misdiagnoses with rheumatoid arthritis and other hand surgical diagnoses, such as osteoarthritis of the thumb base and Dupuytren's disease with contracture, are common, especially when deformities occur early and in the absence of cardinal parkinsonian signs, 1,11 which makes the judgment of the condition complex for an untrained eye 1,4 …”

“…of PD symptoms, such as resting tremor, micrography and difficulties in handling objects due to bradyÀ/hypokinesia. 1,4,10 Moreover, misdiagnoses with rheumatoid arthritis and other hand surgical diagnoses, such as osteoarthritis of the thumb base and Dupuytren's disease with contracture, are common, especially when deformities occur early and in the absence of cardinal parkinsonian signs, 1,11 which makes the judgment of the condition complex for an untrained eye. 1,4 In hand surgical terms, the SHD posture refers to the intrinsic-plus hand, caused by muscle spasm and/or adhesions of the intrinsic muscles in the hand.…”

Dysfunction in parkin aggravates inflammatory bone erosion by reinforcing osteoclast activity

“…For instance, IL-1β can induce bone erosion at the joint in ammation sites of rheumatoid arthritis (RA) via the orchestrated activation of OCs (30,31) and the induction of other proin ammatory cytokines, such as tumor necrosis factor (TNF) and interleukin-6 (IL-6), which are secreted within in amed synovium in patients with RA, contributing to the pain and functional disability (27)(28)(29). The clinical evidence that PD causes joint deformities mimicking RA (32,33) supports the possible link between PD progression and in ammatory bone loss, although direct molecular evidence is currently lacking.…”