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A woman in her 40s with long-standing IgM-rheumatoid factor and anti-cyclic citrullinated peptide positive, erosive rheumatoid arthritis (RA) presented with pain and swelling of the second and third metacarpophalangeal (MCP) joints of the right hand. Seven years earlier, she had received MCP II and III silicone implants and an arthrodesis of MCP I of her right hand because of severe joint destruction despite intensive treatment (figure 1A). At presentation radiographic examination showed loosening of both prostheses with extensive lucencies at the prosthesis–bone interface (figure 1B); other joints showed no progression of her erosive disease. Histological examination revealed amorpheous inclusions in the inflamed connective tissue, surrounded by an intense foreign body giant cell reaction (figure 1C,D). The inclusions and the surrounding connective tissue were analysed using …
Handling editor Josef S Smolen
Contributors LvdW drafted the manuscript, prepared the submission and was involved in the clinical care of the patient. MM reviewed the manuscript and was the consultant radiologist involved in the patient’s care. PDG reviewed the manuscript and was the hand surgeon involved in the patient’s care. TN, MJ, CO and TJ reviewed the manuscript and provided us with the bright field histology and Raman spectroscopy information. NdV and SWT reviewed the manuscript and were the supervising consultant rheumatologists in charge of the patient’s care. All authors approved the submitted version. The patient gave written informed consent for the publication of this report and the use of the accompanying images.
Funding TN is funded by a PPP Allowance made available by Health-Holland, Top Sector Life Sciences & Health, to Stichting ReumaNederland to stimulate public–private partnerships.
Competing interests CO discloses a potential conflict of interest as a managing director, cofounder and shareholder of Hybriscan Technologies B.V., Nijkerk, the Netherlands. The other authors declare no competing interests.
Provenance and peer review Not commissioned; externally peer reviewed.