Review Question - QID 104586

This patient is presenting with osteoarthritis given her joint pain, narrowing of the joint space on radiography, and Heberden and Bouchard nodes on her hands.

Osteoarthritis has an insidious onset. It most often affects the weight-bearing joints in the knees, hips, lumbar and cervical spine, as well as the hands. Radiographic changes include joint space narrowing, osteophytes, subchondral sclerosis, and subchondral cysts. Risk factors include age, obesity, excessive joint loading, trauma, and genetic predisposition. Diagnosis involves both radiographs and history and physical. The treatment of osteoarthritis is weight loss, strengthening of nearby/supporting muscles, NSAIDs, acetaminophen, and in refractory cases, joint replacement.

Figure/Illustration A depicts Heberden (distal arrows) and Bouchard (proximal arrows) nodes which are found in osteoarthritis. Figure/Illustration B shows joint space narrowing in the knee (arrow).

Incorrect Answers:
Answer 2: Reactive arthritis is a seronegative spondyloarthropathy that manifests as an acute and asymmetric oligoarthritis that typically occurs 2-6 weeks after infection.

Answer 3: Rheumatoid arthritis presents in women with symmetric joint pain that is usually worse in the morning and relieved with repeat joint use. It can be associated with other systemic manifestations like fever, fatigue, and malaise.

Answer 4: Septic arthritis presents with a red, hot, and tender joint that must be managed with arthrocentesis, broad spectrum antibiotics, and surgical washout.

Answer 5: Systemic lupus erythematosus commonly presents in a young woman with arthralgias (symmetric), malar/discoid rash, oral ulcers, serositis, and many other laboratory derangements.

Bullet Summary:
Osteoarthritis presents with a cold and painful joint (that is typically weight bearing) and is associated with a narrowing of the joint space on radiography.