Review Question - QID 106427

This radiograph demonstrates complete loss of the articular cartilage at all four distal interphalangeal (DIP) joints, large osteophytes, and ankylosis of the DIP joint of the middle finger, making OA (answer 2) the most likely diagnosis.

OA is a degenerative joint disease that typically occurs after age 40. The proximal interphalangeal joint (PIP)/DIP, foot, knee, and hip joints are commonly affected, while the metacarpophalangeal (MCP), shoulder, wrist, and elbow joints are rarely implicated. Symptoms include pain and stiffness that worsens with activity (and, if occurring upon awakening in the morning, lasts less than an hour). Classic radiographic findings include joint space narrowing, subchondral sclerosis, subchondral cysts, and osteophytes.

While these clinical characteristics are more suggestive of OA over other arthritides, Peat et al. note that OA has no absolute clinical criteria. Thus, a clinical diagnosis of OA is supported by the presence of typical symptoms, physical examination, imaging features, and, occasionally, laboratory findings.

As Altman et al. established, a classic method for diagnosing OA is the presence of pain plus several clinical characteristics including being greater than 50 years old, having morning stiffness for less than 30 minutes, crepitus on active motion (especially in the knee), bony tenderness, bony enlargement, and no palpable warmth.

Figure A demonstrates the classic radiographic findings seen in OA.

Incorrect Answers:
Answer 1: Gouty arthritis is usually monoarticular and tophi may appear on imaging.
Answer 3, 5: RA and SLE would present with constitutional symptoms and different radiographic findings.
Answer 4: Psoriatic arthritis shows a pencil-in-a-cup deformity on imaging.