TY - JOUR T1 - Clinical image: synovitis of the metacarpophalangeal joints JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis DO - 10.1136/ard-2022-223290 SP - ard-2022-223290 AU - Linda van der Weele AU - Tom Niessink AU - Mario Maas AU - Peter Don Griot AU - Matthijs Janssen AU - Cees Otto AU - Tim L Jansen AU - Sander W Tas AU - Niek de Vries Y1 - 2022/11/14 UR - http://ard.bmj.com/content/early/2022/11/14/ard-2022-223290.abstract N2 - 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 … ER -