The deformities seen in these hands are the result of rheumatoid arthritis, a form of autoimmune disease in which many tissues can be involved, but the joints are most affected from an inflammatory synovitis with destructive pannus formation. Erosion of cartilagenous joint surfaces leads to characteristic ulnar deviation of fingers with swan-neck abnormality. The small joints of hands and feet are usually affected first, followed by wrists, elbows, ankles, and knees. The exact cause is unknown, but CD4 cells aggregate and secrete cytokines to attract B cells and macrophages to form the inflammatory response. Many patients form IgM antibodies to Fc receptors of their own IgG, and these immune complexes are the cause for extra-articular manifestations, and they can be measured as "rheumatoid factor" (RF) in blood.
| Our winner is: Nick Manton of Adelaide, South Australia, AUSTRALIA
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