Image Based Question – 74918

A woman presents with pain, swelling and redness of knee joint and hand. There were associated complaints of Morning stiffness with problem in squatting. The swelling spared the DIP joints. The image of the patient’s hands is shown below. What is the most likely diagnosis?

A. Rheumatoid Arthritis

B. Heberden nodes on preexisting osteo arthritis

C. Tenosynovitis of extensor tendon of MCP joints

D. Post traumatic dystrophy with Complex regional pain syndrome

Correct Answer » A Explanation

Ans: A. Rheumatoid Arthritis

(Ref: Harrison, 18tL Ed., pg. 2738-274 1 , 2739f, 2740)

Common Joint Deformities in RA

Boutonniere deformity:

• The middle finger joint bends toward the palm while the outer finger joint may bend opposite the palm.

Swan-neck deformity:

• The base of the finger and the outermost joint bend, while the middle joint straightens.

Hitchhiker’s thumb:

• The thumb flexes at the metacarpophalangeal joint and hyperextends at the interphalangeal joint below your thumb nail.
• It is also called Z-shaped deformity of the thumb.
• OA most commonly affects three parts of the hand:
• The trapeziometacarpal [TMC] or carpometacarpal [CMC] joint
• The distal interphalangeal [DIP]joint
• The proximal interphalangeal [PIP]joint