How are the clinical aspects of chronic RA?

When we have long lasting inflammation (chronic RA), we will get deformities (Boutonniere, Z shape, A swan neck, ulnar drift, volar subluxation) mainly in MCP, PIP and DIP. We get involvement of C1-C2 (antlantoaxial subluxation) due to synovial mmb between C1 and C2, this is rare and severe life threat, we get persistent synovitis produce erosion at dens and transverse ligament lead to instability, which is risk of rupture and anterior displacement of the dens compressing the spine which may lead to death. As for lower limbs we should check for deformities in MTPs, malate, hallus valgus, subluxation of foot arch, pennus nodules on extensors (rheumatic nodules in seropositive disease). Other joints shoulder elbows TMJ cricoarythenoid, see bursitis or flexor tenosynovitis)