Robust rheumatoid arthritis

Arthritis
Robustus: review of a case of an “abnormal” rheumatoid. Radiograph of both hands. Note the prominent erosion in the left 2nd MCP.
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Robust rheumatoid arthritis refers to a rare variant of rheumatoid arthritis with marked subchondral cysts and preserved bone density .

Epidemiology

This entity is very rare, but is thought to occur more-so in males, especially those who are involved in physical labor .

Clinical presentation

Location and distribution of disease are most predominantly in the wrist (distal raioulnar, radiocarpal joints) and hands (metacarpophalangeal and interphalangeal joints), but may also affect different locations, such as feet. Compared to rheumatoid arthritis, patients present with much more attenuated pain and stiffness, and may even be asymptomatic .

Pathology

Etiology is unknown, but thought to be related to use of hands with manual labor.

Radiographic features

General appearance is typical of rheumatoid arthritis:

  • bilateral
  • symmetric
  • marginal erosions
  • ulnar deviation of metacarpophalangeal joints
  • synovial prolipheration

Notable differences between it and rheumatoid arthritis:

  • large subchondral cyst formations disproportionate to erosive changes
  • lack of osteopaenia

History and etymology

Also known as arthritis robust or rheumatoid robustus, this entity was first described by de Haas WH et al. in 1973 .