title: Failure of small joint arthrodesis from resorption around a compression screw in a patient with lupus-associated arthritis mutilans: case report.
abstract: We report the unusual case of a patient with systemic lupus erythematosus (SLE)-associated arthritis mutilans. Arthritis mutilans is a variant of erosive arthritis that is more commonly reported with psoriatic and rheumatoid arthritis and not with SLE. Joint fusion has been shown to be the most effective measure to preserve bone length and prevent further erosive joint changes in arthritis mutilans. We attempted to enhance success of a thumb interphalangeal joint fusion in our patient by adding compression across the fusion with implant screws, given the difficulty of achieving solid bone fusion ordinarily. Osteolysis around the compression screw resulted in arthrodesis failure. We were finally able to achieve successful fusion with iliac crest corticocancellous bone grafts and Kirschner wire fixation. Implant athroplasty in patients with bone loss is risky as it often furthers joint instability because of bone resorption around the prosthesis. This is a point of caution regarding use of any implant (including large screws) in patients with arthritis mutilans, as osteolysis around the implant may occur.
authors.affiliation: Office of Student Affairs, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
authors.forename: Oluseyi
authors.initials: O
authors.lastname: Aliu
authors.forename: David T
authors.initials: DT
authors.lastname: Netscher
authors.forename: Marcia
authors.initials: M
authors.lastname: Peltier
references.citation: Hand Clin. 1996 Aug;12(3):591-602
references.pmid: 8842722
references.citation: Ann Rheum Dis. 1976 Jun;35(3):206-12
references.pmid: 984900
references.citation: Hand Clin. 1996 Aug;12(3):603-14
references.pmid: 8842723
references.citation: Hand Clin. 1989 May;5(2):137-44
references.pmid: 2661570
references.citation: J Hand Surg Am. 1976 Nov;1(3):210-20
references.pmid: 1018089
references.citation: Scand J Rheumatol. 1999;28(1):38-40
references.pmid: 10092163
references.citation: J Hand Surg Am. 1988 Jul;13(4):510-5
references.pmid: 3418052
references.citation: J Hand Surg Am. 1981 Jul;6(4):339-45
references.pmid: 7252104
references.citation: J Bone Joint Surg Am. 1974 Sep;56(6):1207-15
references.pmid: 4436356
references.citation: Hand Clin. 1989 May;5(2):145-55
references.pmid: 2661571
references.citation: J Hand Surg Am. 1982 Sep;7(5):492-7
references.pmid: 6982295
references.citation: J Hand Surg Am. 1982 Mar;7(2):203-7
references.pmid: 7069178
references.citation: Rheumatism. 1965 Oct;21(4):86-90
references.pmid: 5831427
references.citation: Am J Med. 1959 Sep;27:454-62
references.pmid: 13846114
references.citation: J Bone Joint Surg Am. 1972 Apr;54(3):435-55
references.pmid: 5055146
references.citation: J Bone Joint Surg Am. 1971 Oct;53(7):1377-82
references.pmid: 4939959