Severe rheumatoid arthritis hand deformity.

To cite: Harb A, Shawwa K, Alraiyes AH, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013009884 DESCRIPTION A 49-year-old woman with a medical history of hypertension and rheumatoid arthritis presented with severe bilateral hand pain due to arthritis. She was diagnosed with rheumatoid arthritis at the age of 20 years and has been on anti-inflammatory medications and steroids since then. She was treated with methotrexate for a short period of time, but this was stopped due to gastrointestinal intolerance. She has been on prednisone and ibuprofen only for the last 15 years and has been a nursing home resident for the last 5 years due to severe hand deformities and inability to use her hand to take care of herself. On examination, she had a remarkable hand deformity significant for ulnar deviation, boutonniere deformity, swan neck deformity and Z-thumb resulting in permanent deformity and impaired functioning (figures 1 and 2). After admission, she was started on higher dose ibuprofen and prednisone 60 mg orally daily for controlling pain. She continued to refuse any disease-modifying antirheumatic drugs. Hand surgery team saw her as well; however, she declined any surgical intervention, which could help her regain some functions of her hands. She was discharged back to nursing home with better-controlled pain. Rheumatoid arthritis can be a disabling and painful condition, which can lead to a substantial loss of functioning and mobility if not adequately treated. The treatment focuses on controlling the symptoms and preventing joint damage. Various treatment modalities are available, which include tumour necrosis factor alpha blockers such as etanercept, infliximab and adalimumab. 2