A 60-year-old female patient complains of pain in the hands that is worse in the morning. On physical examination, the thumb metacarpophalangeal joint is swollen on both hands
There is swelling of the proximal and distal interphalangeal joints bilaterally. These are typical signs of:
A. Osteoarthritis
B. Rheumatoid arthritis
C. Normal aging
D. Gouty arthritis
ANS: A
Compared with RA, OA has a higher likelihood of affecting larger joints, such as the hips and knees. Like RA, OA also frequently involves the small joints of the hands, although it tends to occur at the distal interphalangeal joints (Heberden's nodes) and proximal interphalangeal joints (Bouchard's nodes). Most frequently, the second and/or third digits and the base of the thumb are involved. The distribution is asymmetrical. The pain and stiffness associated with OA often improve with moderate use and are worse after extended periods of rest. If three or more metacarpophalangeal joints are swollen, the differential should include RA.
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