Concurrence of interphalangeal osteoarthritis and rheumatoid arthritis

G. E. Ehrlich

University of Pennsylvania, Philadelphia, PA, USA

Correspondence to: G. E. Ehrlich. E-mail: g2e{at}mindspring.com

SIR, The concurrence of haemochromatosis with interphalangeal osteoarthritis (OA) and rheumatoid arthritis (RA) [1] is indeed unusual, but RA in the context of interphalangeal OA is not. In a series of 170 patients who had interphalangeal, usually erosive, OA, 26 (15.3%) later developed RA [2]. All had previously had symmetrical involvement of distal (DIP) and proximal (PIP) interphalangeal joints and to a lesser extent of other hand joints. The superimposition of RA suggested ‘Pfropfarthrose’ [3], an engrafting that the highly inflammatory OA presaged.

As Crain [4] has already noted, however, Bouchard's nodes might be a misnomer, as what Bouchard described [5] were PIP nodes in young patients, with flexion deformities, as a consequence, he surmised, of ‘gastric dilatation', thus not what today are given the eponym.

The author has declared no conflicts of interest.

References

  1. Schedel J, Wimmer A, Friedrich A et al. Unusual co-incidence of Heberden's and Bouchard's osteoarthritis, rheumatoid arthritis and haemochromatosis. Rheumatology 2003;42:1109–12.[Free Full Text]
  2. Ehrlich GE. Inflammatory osteoarthritis. II. Superimposition of rheumatoid arthritis. J Chron Dis 1972;25:635–43.[ISI][Medline]
  3. Boni A. Die progredient chronische polyarthritis. In: Boni A, Schoen R, Miehlke R, eds. Klinik der rheumatischen erkrankungen. Berlin: Springer, 1970;156.
  4. Crain DC. Interphalangeal osteoarthritis. J Am Med Assoc 1961;175:1049–53.[ISI][Medline]
  5. Bouchard CJ. Lecons sur les auto-intoxications dans les maladies profesees a la Faculte de medicine de Paris pendant l’annee 1885. Paris: F. Savy, 1887;178–80.
Accepted 31 October 2003





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