G. Willow Wilson talks to us about what it’s like to land a dream project like “The Dreaming” only to have it stuck in limbo due to the pandemic; she also reveals her blunt assessment of her recent stint on Wonder Woman, and explains how she approached the world-building of her Dark Horse comic, The Invisible Kingdom. Oh, and she explains how she became the queen of Twitter Dutch Babies!
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G. Willow Wilson On Pandemic Baking, Wonder Woman & Joining The Sandman Universe | Behind The Panel
Dr. Ebraheim’s educational animated video describes the conditions of arthritis of the fingers.
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Arthritis of the Fingers
Diagnosing arthritis of the fingers can be difficult. Arthritis can affect any joint in the body but it is commonly seen in the joints of the fingers. The different types of arthritis and the pattern of joint involvement include osteoarthritis, psoriatic arthritis, gouty arthritis, rheumatoid arthritis. Heberden’s nodes are hard or bony swellings that can develop in the distal interphalangeal joints (DIP) and may or may not be painful. Heberden’s nodes are caused by the formation of osteophytes due to repeated trauma at the joint and usually occurs during middle age. Bouchard’s nodes are bony growths that can form on the proximal interphalangeal joints of the finger (PIP). Bouchard’s nodes, like Heberden’s nodes, may or may not be painful. Bouchard’s nodes are typically associated with limited motion of the affected joint. Mucous cysts are small, fluid-filled sacs that form between the DIP joint of the finger and the bottom of the fingernail. The best treatment is surgical excision of the cyst and removal of the underlying osteophyte to decrease the risk of recurrence. It is an anti-inflammatory form of arthritis, and it is sometimes mistaken for osteoarthritis. Dactylitis is also referred to as “sausage digit”. It is inflammation of the entire digit. Sausage fingers is a major finding of psoriatic arthritis. Nail pitting is small depressions in the finger nails, and it is most common in people who have psoriasis. Gout is a form of inflammatory arthritis that is sometimes called “gouty arthritis”. Gouty arthritis will mimic infection and may develop in people who have high levels of uric acid in the blood. The uric acid can form needle like crystals in the joint and cause pain, tenderness, swelling, and tenosynovitis. Periarticular erosions seen on x-ray may also be present with gout of the finger joints. Periarticular erosions are usually multiple and bilateral with sclerotic borders. In juvenile rheumatoid arthritis, it is ANA positive in 30% of the time. Rheumatoid factor is negative in a child and later on it may become positive, and there is shortened digits. Polyarticular rheumatoid arthritis (JRA) is a form of juvenile rheumatoid arthritis that affects five or more joints; it is polyarticular in about 30%. Pauciarticular juvenile idiopathic arthritis (JIA) is a form of juvenile rheumatoid arthritis that affects less than five joints; it is pauciarticular in about 50%. In pauciarticular onset juvenile idiopathic arthritis, check the iris of the eye for iridocyclitis. In polyarticular rheumatoid arthritis, check cervical spine for subaxial instability. Rheumatoid arthritis of the hand occurs more in females than in males. Rheumatoid arthritis has spontaneous remissions and exacerbations. The disease can have a systemic nature. Rheumatoid arthritis is typically poly-articular, bilateral and symmetrical, and most commonly affects the hands and feet. The patient complains of pain and stiffness of the joints, especially in the morning (morning stiffness). X-rays show periarticular erosions at the time of diagnosis. Osteopenia and minimal osteophyte formation favor the diagnosis of rheumatoid arthritis. Early (acute) rheumatoid arthritis has symptoms of hot, swollen, tender joints (synovitis). Complicated rheumatoid arthritis has symptoms of digital vasculitis, ecchymosis, skin atrophy, and nodules. Advanced rheumatoid arthritis has symptoms of swelling of the MCP joint, lateral slippage of extensor tendons and tendon ruptures, ulnar deviation of fingers, and x-ray shows destruction of the MCP joints with subluxation, ulnar deviation, and wrist destruction. Finger deformities include mallet finger, boutonniere, and swan neck. The thumb is also involved. These changes occur due to proliferation, inflammation and hypertrophy of the synovium. Involvement of the distal radioulnar joint is usually associated with rupture of the extensor digiti minimi.
