A 50-year-old man presents to the clinic complaining of fatigue and painful swelling of both hands. He also describes being very "stiff' in the morning and requires much longer time to get ready for work. On physical examination, there is erythema, swelling, and tenderness on palpation of the proximal interphalangeal joints and MCP joints. The pattern of joint swelling is symmetric. Plain x-rays of the hand are ordered. Which of the following x-ray findings is characteristic of this condition?
High-Yield Explanation
This patient has features of rheumatoid arthritis, and early in RA there may not be any bony changes seen on x-ray, except nonspecific findings of soft tissue swelling and joint effusions. With longer active inflammation of the joints, loss of cartilage, and bony erosions can be seen. The value of x-rays is to determine the extent of bone and cartilage damage.