Review Question - QID 108991

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Osteoarthritis Presentation Symptoms QID: 108991 (M2.OR.17.4754)

QID 108991 (Type "108991" in App Search)

A 69-year-old man presents to his primary care physician for pain when he walks. He states that the pain is the worst in his left great toe but is also present in his hips and knees. He says that his symptoms are worse with activity and tend to improve with rest. His symptoms have progressively worsened over the past several years. He has a past medical history of obesity, type II diabetes mellitus, smoking, and hypertension. He drinks roughly ten beers per day. His current medications include metformin, insulin, lisinopril, and hydrochlorothiazide. The patient has a recent travel history to Bangkok where he admits to having unprotected sex. On physical exam, examination of the lower extremity results in pain. There is crepitus of the patient's hip when his thigh is flexed and extended. Which of the following is the most likely diagnosis?

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Osteoarthritis

63%

39/62

Rheumatoid arthritis

0/62

Infectious arthritis

11%

7/62

Gout

21%

13/62

Pseudogout

1/62

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This patient is presenting with chronic pain in his joints that is worsened with activity and relieved by rest suggesting a diagnosis of osteoarthritis.

Osteoarthritis occurs secondary to degeneration of the cartilage in the joint. Common locations for it to occur include, but are not limited to, the hip, knee, and great toe. Risk factors include trauma, overuse, increasing age, and obesity. Patients will typically complain of pain in the joint that is exacerbated by activity and relieved by rest. There is often pain and crepitus in the effected joint. Treatment involves weight loss, physical activity as tolerated, and NSAIDs as needed. Ultimately these patients may need surgery to manage their symptoms.

Incorrect Answers:
Answer 2: Rheumatoid arthritis presents with symmetric pain and stiffness in the joints that is worse in the morning and improves with activity. It typically occurs in female patients and can be associated with systemic symptoms. Anti-CCP is a specific test for making this diagnosis.

Answer 3: Infectious arthritis is possible given this patient's history of unprotected sex. However, infectious arthritis tends to present with a hot, inflamed, and erythematous joint. The insidious onset of this patient's symptoms and the association with activity point more towards a diagnosis of osteoarthritis.

Answer 4: Gout typically presents with severe pain and inflammation in the great toe. Though this patient is experiencing symptoms in his great toe, his symptoms are not described as sudden or episodic but rather are insidious. Of note this patient has risk factors for gout of obesity, alcohol consumption, and thiazide diuretic use.

Answer 5: Pseudogout typically causes symptoms that are more insidious than gout and tend to affect the wrist, ankle, and knee. This patient's symptoms have worsened over years and are associated with pain with activity and crepitus suggesting a diagnosis of osteoarthritis.

Bullet Summary:
Osteoarthritis presents with pain in weight bearing joints that is typically worse with activity and relieved by rest.

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