Hand osteoarthritis — SCE Rheumatology MCQ

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EasyOsteoarthritis and Soft Tissue RheumatologyHand osteoarthritisSCE Rheumatology

A 63-year-old woman has gradually progressive pain and bony swelling in DIP and first CMC joints. Morning stiffness lasts 5 minutes and inflammatory markers are normal. Radiographs show osteophytes and joint-space narrowing. There is no synovitis at MCP joints. What is the most likely diagnosis?

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Correct answer: A — Hand osteoarthritis

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · B = shown as D · C = shown as E

Hand osteoarthritis is best because DIP and thumb-base bony OA with brief stiffness and normal inflammatory markers supports hand osteoarthritis. A is less suitable because PsA may affect DIP joints but would have psoriasis, nail disease or dactylitis; B is less suitable because gout causes episodic crystal flares or tophi; C is less suitable because RA usually affects MCP/PIP joints with prolonged inflammatory stiffness; E is less suitable because SLE arthritis is typically non-erosive inflammatory arthralgia. Clinical pearl: thumb-base involvement is a common functional problem in hand OA.

Reference: NICE NG226