BMJ Case Reports 2013; doi:10.1136/bcr-2013-200035

Opera glass hands: the phenotype of arthritis mutilans

  1. António Marinho
  1. Department of Internal Medicine, Centro Hospitalar Porto, Porto, Portugal
  1. Correspondence to Dr Maria Betânia Ferreira, betania_ferreira82{at}


A 51-year-old man was diagnosed with psoriatic arthritis at the age of 18.

For the last 20 years he refused treatment, abandoned any follow-up and was unseen by any health professional. The patient became unable to walk 17 years ago and then went blind 10 years ago.

The patient entered the emergency room prostrated; on examination, he was found cachetic in appearance, with psoriatic skin eruptions and nail changes, axial anquilosis and hands with ‘telescopic fingers’ (figures 1 and 2)

Figure 1

Patient's hands: shows redundant skin over shortened fingers and onycholysis and nail pitting is visible.

Figure 2

Hands X-ray, depicting the major phases of evolution in psoriatic arthritis: pencil in cup images (*); resorption of bone and dissolution of joints (**); fusion of fingers (***).

Arthritis mutilans is the most severe and destructive form of psoriatic arthritis, range from 3.7% to 6.7% according to different studies.1 When Digit's articular collapse, it leaves redundant overlying skin in shorter fingers, able of a motion like a telescope—the telescopic finger.

Today, with early diagnosis and easy access to disease modifying antirheumatic drugs, such severe deformities are extremely rare.2

Learning points

  • Arthritis mutilans (AM) has been described in association with a wide variety of arthropathies, including rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, systemic sclerosis, Systemic lupus erythematosus and others, being the first two most commonly associated diseases.1 ,2

  • AM is characterised by an asymmetric pattern of peripheral joint involvement, with a predilection for the interphalangeal and metacarpophalangeal joints of the hand and small jointes of the feet.1

  • Radiographically, AM is characterised by the presence of severe boné and joint resorption and deformities.1


  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.


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