Woman's Common Condition Resulted In Rare "Telescoping Fingers"

X-ray images revealed that the woman had experienced osteolysis, or bone resorption. New England Journal of Medicine © 2019

A 69-year-old woman’s case of “telescoping fingers” shows the severe and rare effect rheumatoid arthritis (RA) can have on the human body.

The woman first came to a rheumatology clinic for treatment of joint deformities and notable tenderness and swelling in her hand, wrist, elbow, knees, and left ankle joints.

“Examination of the hands also showed shortened fingers with loss of active finger flexion and an inability to make a fist,” wrote her physician in the New England Journal of Medicine. When doctors pulled and stretched on her fingers, the “digits returned to their original positions” after being released, as you can see in the video below.

 

X-ray images revealed that the woman had experienced osteolysis, or bone resorption, of the ulna and radius (forearm bones), as well as the bones in her fingers. Osteolysis occurs when bones lose minerals, namely calcium, becoming weaker until the bone tissue is ultimately destroyed. The woman was subsequently diagnosed with arthritis mutilans, a severe form of chronic rheumatoid arthritis characterized by “destructive erosive arthritis” where the joints collapse into themselves.

“The observed telescoping phenomenon is a consequence of this bone resorption,” wrote the physician.

IFLScience spoke with a California-based physician who did not treat the patient. She said that telescoping fingers is an extreme result of rheumatoid arthritis and is notably rare given modern diagnostic techniques and the antirheumatic drugs available on the market today. RA is the most common type of autoimmune arthritis, affecting 1.5 million people in the US alone, according to the Arthritis Foundation. It occurs when the immune system doesn’t work properly, causing pain and swelling in the wrist and small joints of the hands and feet, notes the American College of Rheumatology. Treatment typically entails disease-modifying antirheumatic drugs to relieve symptoms and slow the progression of joint damage. A 2016 case of a 55-year-old woman who had been diagnosed with psoriatic arthritis seven years earlier recovered the function of her hand following orthopedic surgery.

However, the 69-year-old woman was largely unresponsive to such treatments. The woman received a treatment of several RA drugs, as well as a low-dose prednisone to reduce the pain and swelling. However, her hand functionality did not change.

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