<prompt> All are seen in Rheumatoid arthritis EXCEPT:Boutonnieres deformityHeberden nodesInvolvement of PIPSwan neck deformity  <response>: Ans. b Heberdens nodesRef: Harrison 18th ed. ch. 332Heberderis nodes are hard or bony swellings that develop in the distal interphalangeal joints DIP in a case of osteoarthritisClinical Features of Rheumatoid ArthritisThe presenting symptoms of RA typically result from inflammation of the joints, tendons, and bursae.Early morning joint stiffness lasting more than 1 hour and easing with physical activity. The earliest involved joints are typically the small joints of the hands and feet. The initial pattern of joint involvement may be monoarticular, oligoarticular4 joints, or polyarticular 5 joints, usually in a symmetric distribution Wrists, metacarpophalangeal MCP and proximal interphalangeal PIP joints stand out as the most frequently involved joints. The frequent hallmark of RA: Flexor tendon tenosynovitis.Deformities Ulnar deviation of the hand. Swan-neck deformity: Hyperextension of the PIP joint with flexion of the DIP Boutonniere deformity: Flexion of the PIP joint with hyperextension of the DIP joint Z-line deformity Subluxation of the first MCP joint with hyperextension of the first interphalangeal IP joint Inflammation about the ulnar styloid and tenosynovitis of the extensor carpi ulnaris may cause subluxation of the distal ulna, resulting in a piano-key movement of the ulnar styloid Metatarsophalangeal joint MTP involvement is a feature of early disease in the feet Atlantoaxial involvement of the cervical spine can cause compressive myelopathy and neurologic dysfunction Most frequent extraarticular manifestations: Subcutaneous nodules, secondary Sjogrens syndrome, pulmonary nodules, and anemia. 