Early Changes of Inflammatory Arthritis in the Hand

This picture shows swelling and mild erythema / bluish tinge at the second, third and fifth PIP joints. Note the loss of the skin folds over the affected joints indicating that synovitis is present. The MCP’s look “full” and could be inflamed. The DIP joints of 3rd DIP and possibly 1st and 4th look enlarged and could represent synovitis or possibly a concomitant Heberden’s node of osteoarthritis. This could represent early RA (with coexisting OA in DIP joints) or early PsA if there is synovitis in the DIPs. (Image Credit: Ms. Nancy Roper)