Article Text

Download PDFPDF

Opera glass hands: the phenotype of arthritis mutilans
  1. Maria Betânia Ferreira,
  2. Nuno Sá,
  3. Sara M Rocha,
  4. António Marinho
  1. Department of Internal Medicine, Centro Hospitalar Porto, Porto, Portugal
  1. Correspondence to Dr Maria Betânia Ferreira, betania_ferreira82{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


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


View Abstract


  • Competing interests None.

  • Patient consent Obtained.

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