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Gold Finger: Metal Jewellery as a Disease Modifying Antirheumatic Therapy!

Hlaing T, Ramteke S, Binymin K - Case Rep Med (2009)

Bottom Line: The disease can progress rapidly causing joint swelling and damaging cartilage and bone around the joints resulting in severe deformities.We postulated that wearing a gold wedding ring has helped protecting the PIP joint of the left ring finger from the damaging effect of inflammatory arthritis.The possible mechanisms by which metal jewellery (gold ring) confer protection to adjacent joints was discussed.

Affiliation: Rheumatology Department, Southport and Ormskirk Hospital NHS Trust, Liverpool University, PR8 6PN, UK.

ABSTRACT

Polyarticular psoriatic arthritis is a chronic, progressive and disabling auto-immune disease often affecting the small joints of the hands in a symmetrical fashion. The disease can progress rapidly causing joint swelling and damaging cartilage and bone around the joints resulting in severe deformities. We report a very unusual case of a 49-year-old woman who presented with polyarticular psoriatic arthritis affecting all proximal interphalangeal (PIP) joints of both hands except the left ring finger PIP joint. On clinical examination there was no evidence of arthritis in the left ring finger PIP joint. We confirmed the paucity of joint damage in the PIP joint of the left ring finger using more modern imaging modalities such as musculoskeletal ultrasound and MRI scan of the small joints of the hands. All other PIP joints in both hands demonstrated advanced degrees of joint damage secondary to chronic psoriatic inflammatory arthritis. We postulated that wearing a gold wedding ring has helped protecting the PIP joint of the left ring finger from the damaging effect of inflammatory arthritis. The possible mechanisms by which metal jewellery (gold ring) confer protection to adjacent joints was discussed.

MRI of the proximal interphalangeal joints of both hands confirms sparing of the left ring proximal interphalangeal joint. All other proximal interphalangeal joints show marked synovitis and erosions.
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fig2: MRI of the proximal interphalangeal joints of both hands confirms sparing of the left ring proximal interphalangeal joint. All other proximal interphalangeal joints show marked synovitis and erosions.

Mentions: A 49-year-old right-handed female was admitted for investigation of recent joint swelling affecting the small joints of the hands. She admits to have intermittent arthritis of the hands for the past 3 years. On examination, there was synovitis at the proximal interphalangeal (PIP) joints in a symmetrical distribution of all the fingers of both hands except the PIP joint of the left ring finger (Figure 1). There was also prominent nail (Figure 1) and skin changes consistent with psoriasis. The inflammatory markers were raised, and tests for the RF latex and anticyclic citrullinated peptide antibodies were negative. The diagnosis of symmetric polyarticular psoriatic arthritis was made. Anteroposterior radiograph of the hands showed subchondral erosions with periosteal reaction in all of the PIP joints sparing the left ring finger PIP joint. MRI scan (Figure 2) and ultrasound studies (USs) of the hands confirmed the presence of joint space narrowing and extensive synovitis with articular erosions at the PIPs of all the fingers sparing the left ring finger PIP joint. The patient is married and wore a 22-carat gold wedding ring on the left ring finger throughout her marriage for the last 26 years.

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Gold Finger: Metal Jewellery as a Disease Modifying Antirheumatic Therapy!

Hlaing T, Ramteke S, Binymin K - Case Rep Med (2009)

MRI of the proximal interphalangeal joints of both hands confirms sparing of the left ring proximal interphalangeal joint. All other proximal interphalangeal joints show marked synovitis and erosions.
© Copyright Policy
fig2: MRI of the proximal interphalangeal joints of both hands confirms sparing of the left ring proximal interphalangeal joint. All other proximal interphalangeal joints show marked synovitis and erosions.
Mentions: A 49-year-old right-handed female was admitted for investigation of recent joint swelling affecting the small joints of the hands. She admits to have intermittent arthritis of the hands for the past 3 years. On examination, there was synovitis at the proximal interphalangeal (PIP) joints in a symmetrical distribution of all the fingers of both hands except the PIP joint of the left ring finger (Figure 1). There was also prominent nail (Figure 1) and skin changes consistent with psoriasis. The inflammatory markers were raised, and tests for the RF latex and anticyclic citrullinated peptide antibodies were negative. The diagnosis of symmetric polyarticular psoriatic arthritis was made. Anteroposterior radiograph of the hands showed subchondral erosions with periosteal reaction in all of the PIP joints sparing the left ring finger PIP joint. MRI scan (Figure 2) and ultrasound studies (USs) of the hands confirmed the presence of joint space narrowing and extensive synovitis with articular erosions at the PIPs of all the fingers sparing the left ring finger PIP joint. The patient is married and wore a 22-carat gold wedding ring on the left ring finger throughout her marriage for the last 26 years.

Bottom Line: The disease can progress rapidly causing joint swelling and damaging cartilage and bone around the joints resulting in severe deformities.We postulated that wearing a gold wedding ring has helped protecting the PIP joint of the left ring finger from the damaging effect of inflammatory arthritis.The possible mechanisms by which metal jewellery (gold ring) confer protection to adjacent joints was discussed.

Affiliation: Rheumatology Department, Southport and Ormskirk Hospital NHS Trust, Liverpool University, PR8 6PN, UK.

ABSTRACT

Background: Polyarticular psoriatic arthritis is a chronic, progressive and disabling auto-immune disease often affecting the small joints of the hands in a symmetrical fashion. The disease can progress rapidly causing joint swelling and damaging cartilage and bone around the joints resulting in severe deformities. We report a very unusual case of a 49-year-old woman who presented with polyarticular psoriatic arthritis affecting all proximal interphalangeal (PIP) joints of both hands except the left ring finger PIP joint. On clinical examination there was no evidence of arthritis in the left ring finger PIP joint. We confirmed the paucity of joint damage in the PIP joint of the left ring finger using more modern imaging modalities such as musculoskeletal ultrasound and MRI scan of the small joints of the hands. All other PIP joints in both hands demonstrated advanced degrees of joint damage secondary to chronic psoriatic inflammatory arthritis. We postulated that wearing a gold wedding ring has helped protecting the PIP joint of the left ring finger from the damaging effect of inflammatory arthritis. The possible mechanisms by which metal jewellery (gold ring) confer protection to adjacent joints was discussed.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2760131&rFormat=json&query=null&req=5