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Red and yellow flags
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
Several questions can be asked to help consider a possible diagnosis of osteoarthritis: Is there a history of trauma?Have they noticed any other joint swelling? (Look for Heberden’s and Bouchard’s nodes.)Have they had pain, swelling and stiffness at the base of the thumb?If they have hip pain, do they have any factors that predispose to hip osteoarthritis (previous Perthe’s disease, leg length discrepancy, previous hip trauma)?
Single Best Answer Questions
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Heberden and Bouchard’s nodes are typically seen in which form of joint disease?OsteoarthritisRheumatoid arthritisPsoriatic arthritisCrystal arthritisSeptic arthritis
Answers
Published in Thomas Hester, Iain MacGarrow, Surgical SBAs for Finals with Explanatory Answers, 2018
Osteoarthritis of the hands is associated with bony swellings around the distal interphalangeal joints; these are known as Heberden’s nodes. Nodes at the proximal interphalangeal joints are Bouchard’s nodes. Rheumatoid nodules are often seen around the elbows. Other extra-articular features can be seen in the eyes, e.g. episcleritis; chest signs, e.g. fibrosing alveolitis; cardiac signs, e.g. pericarditis; abdominal signs, e.g. splenomegaly in Felty’s syndrome.
Remission with tocilizumab in a patient with erosive hand osteoarthritis
Published in Scandinavian Journal of Rheumatology, 2021
M Kondo, Y Murakawa, M Honda, M Moriyama
A 59-year-old Japanese woman had noticed that the distal interphalangeal (DIP) joint deformed gradually from two years ago. Finger arthralgia at the DIP and proximal interphalangeal (PIP) joints appeared and worsened gradually. She could not sleep at night because of severe arthralgia. On presentation, Heberden’s and Bouchard’s nodes were present. She had been treated for right breast cancer, but had no history of psoriasis. There was no family history of rheumatoid arthritis, OA, or psoriasis. Laboratory tests revealed slightly high C-reactive protein (0.62 mg/dL, normal < 0.14), and matrix metalloproteinase-3 (61.8 ng/mL, normal 20.9–50.6) levels, and a moderately elevated erythrocyte sedimentation rate (33 mm/h, normal 3–15). Rheumatoid factor and anti-cyclic citrullinated peptide antibody were negative. While the serum tumour necrosis factor (TNF)-α level was not elevated, IL-6 was high at 3.28 (normal < 2.41) pg/mL. Plain X-rays revealed sawtooth and gull-wing erosions of the PIP and DIP joints (Figure 1A). Ultrasonography (US) revealed synovial swelling and a Doppler signals in the swollen joints (Figure 1B). HLA typing showed the presence of the HLA-B44 allele, which is frequently associated with EHOA (1). We diagnosed EHOA and treated her with non-steroidal anti-inflammatory drugs, which were ineffective. Therefore, we started TCZ (via subcutaneous injection, 162 mg biweekly) and her arthralgia improved gradually (Figure 2). Six months later, her tender and swollen joint counts had improved from 8 to 4 and 8 to 2, respectively. Her visual analogue scale for pain also improved, from 64 to 15 (mm). The synovial swelling and Doppler signals on US improved remarkably (Figure 1B).