Dual Antibody Positive Rheumatoid Feet

An 86-year-old man presented with severe, debilitating, dual antibody positive rheumatoid arthritis associated joint deformities of his upper and lower extremities. These developed over twenty years but were progressive and debilitating. They began in the forefoot and eventually progressed to mid and hindfoot bilaterally. Examination of his lower extremities revealed severe bilateral hallux valgus deformities, traumatic pes planus deformity, right foot metatarsal head subluxation, and bilateral claw and hammer toes. Relentless progression of his lower extremity pain, joint destruction and significant gait limitation was due to a constellation of factors including ongoing tobacco use, dual antibody positivity and intolerance based on side effects to multiple targeted biologic disease-modifying antirheumatic (DMARD) medications including infliximab, etanercept, golimumab and tofacitinib.