Varying stages may be seen in different joints at a single point in time. ![]() The disease continues in the remainder of the MCP and PIP joints. The hands are affected symmetrically, and the disease process is usually visible first at the second and third MCP joints and the third PIP joint. Nodular thickening in the tendon sheath may also produce a trigger finger. Tenosynovitis of the flexor tendons causes a reduction in finger flexion and grip strength. The distal interphalangeal (DIP) joints are involved only in the presence of a coexisting MCP or PIP disease. In the hands, the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and thumb interphalangeal (IP) joints are most frequently involved. Disorganization of the joint leads to deformities and loss of function. RA is characterized by a typical pattern and distribution of synovial joint involvement.
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