Introduction: Recognition of advanced Rheumatoid Arthritis (RA) is usually facilitated by the presence of chronic deformities such as ulnar deviation, metacarpals radial shift and interosseous atrophy. Although being considered typical, these deformities are not pathognomonic of RA and other conditions must be ruled out, especially when the clinical picture is not clear. The authors present 2 clinical cases of RA-like hand deformities. Case 1: A 73-year-old female was referred from the Neurology Department because of suspicion of RA. The patient complained of polyarthralgias involving shoulders, elbows, wrists, PIP, hips, and knees. She also complained of mechanical low back pain and muscle stiffness lasting all day long. She had been diagnosed with Parkinson Disease (PD) 25 years ago and was being treated with ropinirole 8 mg per day and carbidopa/levodopa 25/250mg (6 times per day). Rheumatologic examination revealed the presence of Heberden's and Bouchard's nodes, interosseous atrophy, metacarpals radial shift, reducible ulnar deviation, and kyphosis but no signs of arthritis were present. Rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA) and acute phase markers were negative. Spine radiographs showed old fractures of dorsal and lumbar spine. Proximal interphalangeal (PIP) and distal interphalangeal joint space narrowing with subchondral sclerosis and osteophytosis were seen on hands radiographs. Diagnosis of multifocal osteoarthritis and osteoporosis were made and the patient was started on pain relievers, vitamin D, calcium supplementation and bisphosphonate. The patient was kept on regular follow up, but arthritis was never observed. Case 2: A 73-year-old female presented with a 10-year history of mechanical polyarthralgias (affecting shoulders, elbows, wrists, PIP, hips, knees, and feet) with 30 minutes of morning stiffness. She had an 11-year history of PD, under carbidopa/levodopa 25/100mg (3 times per day), and osteoporosis (with several lumbar osteoporotic fractures). On rheumatologic examination, stood out a reducible ulnar deviation of the left hand and a marked kyphosis. There were no clinical signs of arthritis. RF and ACPA were negative and acute phase markers were normal. Radiographs of the hands and feet showed radiographic generalized osteopenia, without joint space narrowing, erosions or any other typical feature of RA. The patient was diagnosed with osteoporosis and treatment with pain relievers, bisphosphonate and calcium and vitamin D supplementation was started. The patient was kept on regular follow-up, once again, without any signs of arthritis. Conclusion: Both patients showed chronic hand deformities suggestive of advanced RA. However, no clinical evidence of the disease was found in neither case. Interestingly both patients have been suffering from long-standing PD, with osteoporosis. The deformities observed in both these patients hands are named striatal hands and have been reported in 10% of patients with untreated, advanced PD1. Unlike RA, local signs of joint involvement, such as pain, tenderness, heat and swelling are absent in striatal hands. Also, RA tends to occur bilaterally and deformaties are not reducible, whereas focal dystonia before PD tends to be unilateral, with tremor, rigidity, and bradykinesia developing on the ipsilateral side. [ABSTRACT FROM AUTHOR]