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Finger drop in a patient with rheumatoid arthritis
  1. GEORGE E EHRLICH
  1. One Independence Place -1101
  2. 241 South Sixth Street
  3. Philadelphia, Pennsylvania 19106-3731, USA
    1. M D SMITH,
    2. S P McDONALD
    1. Department of Medicine
    2. Flinders Medical Centre
    3. South Road, Bedford Park
    4. South Australia 5042

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      I wish to comment on the case report by McDonald and Smith.1 Although the authors report that a tomographic arthrogram showed no cystic extension of the joint capsule, the two figures are almost identical with those previously seen in antecubital cysts in rheumatoid arthritis.2 These ‘cysts’ are corollaries to the popliteal cysts and are generally missed in physical examinations because the bulge they produce often disappears into the fleshy part of the forearm. Clearly, they represent an escape for the effusion in a joint distended by severe synovitis and its products. The proximity of major nerves puts them at risk, as the paper by McDonald and Smith shows.

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      Authors’ reply

      We thank Dr Ehrlich for his interest in our case report of a patient with a posterior interosseous nerve lesion, secondary to rheumatoid arthritis with synovitis of the elbow joint.1-1 We were not aware of his paper2 describing antecubital cysts in rheumatoid arthritis but, as our case was mainly an illustration of an unusual compressive neuropathy rather than a description of synovial cysts of the elbow joint, we would not have included the topic of his paper in our literature search. We agree that there is a similarity between the arthrograms in Dr Ehrlich’s paper and that illustrated in our paper. Our case reinforces the conclusions of Dr Ehrlich’s paper 23 years ago that antecubital cysts are relatively common, are frequently overlooked, and should be actively sought when a patient with rheumatoid arthritis presents with symptoms suggestive of a compressive neuropathy in the forearm. We hope that our case report and Dr Ehrlich’s letter will remind rheumatologists to consider this potentially treatable cause of upper limb disability in patients with rheumatoid arthritis.

      References

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