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Osteoarthritis — SCE Rheumatology MCQ

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EasyOsteoarthritisOsteoarthritisSCE Rheumatology

A 55-year-old woman has gradually progressive pain and stiffness affecting both first carpometacarpal and distal interphalangeal joints. Examination shows Heberden and Bouchard nodes. Radiographs demonstrate joint-space narrowing, subchondral sclerosis and osteophytes, while ESR and CRP are normal. Prominent structural involvement of which joint group would be least characteristic of primary nodal osteoarthritis and should prompt consideration of an alternative or secondary arthropathy?

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Correct answer: B — MCP joints

The correct answer is B, the MCP joints. Primary nodal hand osteoarthritis characteristically affects the DIP joints, producing Heberden nodes, and the PIP joints, producing Bouchard nodes; first CMC osteoarthritis commonly coexists. First MTP osteoarthritis is also common in primary osteoarthritis. By contrast, prominent MCP disease is atypical, although not biologically impossible, and should prompt consideration of another process. Symmetrical inflammatory MCP synovitis suggests rheumatoid arthritis, whereas second- and third-MCP arthropathy with hook osteophytes suggests haemochromatosis or CPPD-associated arthropathy. The normal inflammatory markers support a non-inflammatory phenotype but do not alone exclude inflammatory arthritis. The revised wording avoids implying that MCP involvement can never occur in OA.

Reference: Marshall M, et al. Development of classification criteria for hand osteoarthritis: comparative analyses of persons with and without hand osteoarthritis. RMD Open. 2020;6:e001265. https://rmdopen.bmj.com/content/6/2/e001265