Connective Tissue Disorders

Linear hemorrhages, i.e. splinter hemorrhages, seen on the nails may be a clue to an underlying connective tissue disease, such as antiphospholipid antibody syndrome.

Heberden’s nodes in the DIP-joints due to formation of bony nodules, a clinical sign seen in patients with osteoarthritis. More commonly seen than Bouchard’s nodes.

Bouchard’s nodes in the PIP-joints due to formation of bony nodules, a clinical sign seen in patients with osteoarthritis.

Prominent scaly fixed erythema, flat or raised over malar eminences, tending to spare nasolabial folds (“butterfly rash”).

Sclerodactyly showing bilateral swelling, a shiny wax-like appearance, and tapering of the fingers. May also note digital ulcers, nailfold telangiectasia, and periarticular calcinosis. Flexion contractures present in advanced disease. (Courtesy Dr. A. Fam)

Note subluxation of digits at the metacarpophalangeal (MCP) joints and rheumatoid nodules at 2nd and 3rd MCPs. (Courtesy of Dr. D. Jerome)

Significant ulnar deviation of the digits, typical of rheumatoid arthritis.

Note white discolouration of digits. (Courtesy of Dr. D. Jerome)

Onycholysis: Lifting of the nail starting at the distal end, seen in psoriatic arthritis. (Courtesy of Dr. D. Jerome)

Nail pitting seen in psoriatic arthritis. (Courtesy of Dr. D. Jerome)