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Arthritis Mutilans - Causes, Symptoms, Diagnosis, and Treatment

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Arthritis mutilans is an extreme type of arthritis seen in psoriatic and rarely rheumatoid arthritis affecting the hands and feet.

Written byDr. Vineetha. V

Medically reviewed byDr. Atul Prakash

Published At March 27, 2023
Reviewed AtFebruary 6, 2025

What Is Arthritis Mutilans?

Arthritis mutilans is also called pencil-in-cup deformities because of its peculiar radiographic appearance. It is characterized by the destruction of the joints and bones, leading to deformities and significant functional impairment. This condition can develop alone but is also seen in individuals with psoriatic or rheumatoid arthritis. However, the rate of developing this condition in rheumatoid arthritis patients is lower than in psoriatic arthritis patients.

Psoriatic arthritis mutilans is typically seen in the toes, wrists, and fingers. This psoriatic arthritis occurs due to severe joint and bone damage that causes the fingers to collapse, resembling the opening of opera glasses or a telescope. Psoriatic arthritis in fingers causes the bones to dissolve, and the soft tissues cannot support the fingers, resulting in a telescoping appearance.

What Are the Causes of Arthritis Mutilans?

The exact reason for arthritis mutilans development is not yet fully understood; however, it is believed to be linked to certain factors, including the following:

Autoimmune Disorders: Psoriatic arthritis and rheumatoid arthritis are chronic autoimmune diseases that cause inflammation and pain in the joints, causing damage and deformity to the joints. Disability caused by both of these conditions impacts the quality of life.

  • Psoriatic arthritis affects some individuals with psoriasis, a skin condition characterized by red, scaly patches. It is a complex disease found in various body parts, including the skin, joints, and nails.

  • Rheumatoid arthritis causes joint inflammation and pain, leading to damage and deformity.

Genetic Factors: Genetic mutations affect the cartilage and bone. Psoriatic arthritis patients with the HLA-B27 gene have a higher chance of developing this condition.

Joint Injury Due to Trauma: Injuries at psoriatic arthritis or rheumatoid arthritis sites can develop arthritis mutilans.

What Are the Symptoms of Arthritis Mutilans?

The symptoms of arthritis mutilans include:

  • Pain: The affected joints may be painful, especially during movements and physical activity.

  • Wearing Out of Joints and Bones: It is seen in hands and feet. These changes occur due to inflammation over the affected area.

  • Joint Disability: Difficulty in moving, bending, or straightening the joints.

  • Swelling: The joints become swollen and tender due to inflammation.

  • Stiffness Due to Bone Fusion: Ankylosis or fusion of bones within the joint creates stiffness and results in limited mobility. The affected joints may feel stiff, especially after periods of inactivity.

  • Deformities: In psoriatic arthritis, toes and fingers become distorted and appear twisted.

  • Restricted Joint Mobility: Joint mobility can become severely limited, making daily activities such as writing, typing, or even walking difficult.

  • Skin Changes: The affected joints will become shorter, forming loose skin in those areas. The skin of joints may appear tight, wrinkled, and shiny.

How Can Arthritis Mutilans Be Diagnosed?

Arthritis mutilans can be diagnosed with the help of the following steps:

  • Physical Examination: A healthcare provider will check the affected joints' pain, swelling, and deformities.

  • Imaging Tests: X-rays or other imaging tests, such as an MRI (magnetic resonance imaging) scan or a CT (computed tomography) scan, can confirm the diagnosis of arthritis mutilans and assess the extent of joint destruction and bone resorption.

  • Blood Tests: Blood tests may be used to check for underlying autoimmune disorders, such as rheumatoid arthritis, or to rule out other conditions that may cause similar symptoms.

  • Rheumatoid Factor (RF) Test: It measures the rheumatoid factor, an antibody found in rheumatoid arthritis patients. High levels of RF indicate an autoimmune disorder but can also be present in other conditions.

  • Anti-Cyclic Citrullinated Peptide (anti-CCP) Test: This test measures the antibodies in the blood against cyclic citrullinated peptides found in the joint. It is peculiar for rheumatoid arthritis.

  • Erythrocyte Sedimentation Rate (ESR) Test: An increased ESR indicates inflammation, a common symptom of arthritis.

  • C-Reactive Protein (CRP) Test: A test that measures the level of CRP, a protein produced in response to inflammation. An elevated CRP level can indicate inflammation in the body, which may be associated with arthritis.

  • Biopsy: It can confirm the diagnosis and assess the severity of joint damage.

What Is the Treatment for Arthritis Mutilans?

Treatment for arthritis mutilans mainly involves a combination of medications and therapies to control pain and inflammation, slow the progression of joint damage, and restore joint function and mobility.

The treatment options for arthritis mutilans include the following:

  • Medications: NSAIDs (nonsteroidal anti-inflammatory drugs) and DMARDs (disease-modifying antirheumatic drugs), such as Methotrexate, may be prescribed to lower pain and slow down joint damage. TNF (tumor necrosis factor) inhibitors like Etanercept can be used to treat psoriatic arthritis.

  • Physical Therapy: Exercises help improve joint mobility and function and help maintain the patient’s independence and quality of life.

  • Helping Devices: Braces, splints, or canes may support the affected joints, reducing the risk of injury.

  • Joint Injections: Corticosteroid joint injections can provide temporary relief from pain.

  • Joint Surgery: Surgery like joint fusion may be performed to correct deformities and improve function. In severe cases, the damaged joints are usually replaced.

What Are the Risk Factors of Arthritis Mutilans?

Arthritis mutilans is a rare condition, so there is little evidence on its prediction of whether it will occur. So far, research into its risk factors has been inconclusive. However, childhood obesity and psoriasis at a young age are considered risk factors. The only known strong indicator of the development of arthritis mutilans is a family history.

Potential risk factors include:

  • Family History: If arthritis mutilans runs in your family, you might be more likely to develop it, too.

  • Genetics: Certain genetic factors could play a role in the development of the condition.

  • Skin Trauma: Injuries to the skin, mainly if they cause inflammation, might be linked to arthritis mutilans in some cases.

  • History of Infection: Having a severe infection that needed antibiotics in the past can be a potential risk factor.

  • Joint Trauma: It can increase the risk of developing this condition.

Conclusion:

Arthritis mutilans is a rheumatological condition. Hence, it is best treated by a rheumatologist. However, other doctors or specialists can also help to form a better and more holistic treatment plan. Moreover, having a steady, healthy, and balanced lifestyle is also of great help. Eating a nutritious diet, working out, taking care of your mental health, and checking your stress can help reduce the symptoms of arthritis mutilans.

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Frequently Asked Questions

 
Another name for arthritis mutilans is "mutilating arthritis." This term is used to describe the severe and destructive form of arthritis that leads to joint deformities and functional impairment. Arthritis mutilans are characterized by the rapid erosion of joint tissues and bone, resulting in significant disability.
Arthritis mutilans is a rare form of arthritis, accounting for less than five percent of all arthritis cases. Its occurrence is relatively uncommon compared to other types of arthritis.
 
Arthritis itself typically does not lead to memory loss. However, some studies suggest that individuals with rheumatoid arthritis, a common type of arthritis, may experience cognitive difficulties or "brain fog." It is important to note that this cognitive impairment is not the same as memory loss.
 
Yes, arthritis can be painful. The pain experienced can vary depending on the type and severity of arthritis, but it is a common symptom of the condition.
 
Arthritis mutilans are not the same as gout. Gout, a type of arthritis, arises from the accumulation of uric acid crystals within the joints, resulting in severe pain and inflammation.
 
The rarest form of arthritis is believed to be Adult-Onset Still's Disease (AOSD). It is a systemic inflammatory disorder characterized by high fevers, rash, and joint inflammation.
 
Yes, it is possible for a person to have multiple types of arthritis simultaneously. This is known as having comorbid arthritis conditions.
Arthritis can affect people of all ages, genders, and ethnic backgrounds. However, it is most commonly seen in older adults. As individuals age, the risk of developing arthritis increases. It is estimated that the prevalence of arthritis is higher among women than men.
The treatment for arthritis mutilans may involve a combination of medications such as disease-modifying antirheumatic drugs (DMARDs) and biologic agents. However, the specific medication regimen would be determined by a healthcare professional based on individual needs.
 
Yes, certain types of arthritis can manifest on the skin. Psoriatic arthritis often accompanies psoriasis, a skin disorder marked by the presence of red, flaky patches.
 
Arthritis can have an impact on mental health. Chronic pain, physical limitations, and the challenges of managing a chronic condition can contribute to feelings of depression, anxiety, and decreased quality of life.
 
Arthritis does not typically affect speech directly. However, if arthritis affects the joints in the jaw or temporomandibular joint (TMJ), it may cause difficulties with speaking or opening the mouth fully.
Yes, arthritis can lead to changes in the shape of fingers. In some forms of arthritis, such as rheumatoid arthritis, joint inflammation can cause deformities, including swan neck deformity and boutonniere deformity, which can affect the shape and function of the fingers.
 
Currently, there is no cure for arthritis. However, there are various treatment options available to manage symptoms, reduce inflammation, and improve quality of life.
 
While there may be a genetic predisposition to developing arthritis, it is not entirely hereditary. The development of arthritis is influenced by a combination of genetic, environmental, and lifestyle factors.
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Dr. Atul Prakash from iCliniq
Dr. Atul Prakash

Orthopedician and Traumatology

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