Erosive osteoarthritis (hands)

Case contributed by Dr Yair Glick

Presentation

Swollen, painful finger joints in both hands.

Patient Data

Age: 70 years
Gender: Female
X-ray

Joint space narrowing and "seagull" erosions in many of the proximal (PIPJ) and distal interphalangeal joints (DIPJ), with periarticular osteophytes. Mild degenerative changes in the 1st carpometacarpal joint (CMCJ1). Subluxation of DIPJ2 and 5 in the left hand. Soft tissue swelling of 2nd finger bilaterally.

Ultrasound

Both hands

  • on the dorsal aspect of the carpus, the radiocarpal and intercarpal joints do not show signs of synovitis
  • the extensor tendons exhibit normal thickness, echogenicity, and course
  • no fluid demonstrated in any tendon sheath

Left hand

  • impression of 3rd metacarpal head erosion
  • osteophytes and joint space narrowing of PIPJ2-5
  • synovitis of PIPJ2-4 fingers, particularly pronounced in PIPJ4 where accompanied by hyperaemia

Right hand

  • osteophytes and joint space narrowing of PIPJ2-4
  • synovitis of PIPJ4, possibly accompanied by a synovial cyst
  • severe degenerative changes with synovitis, osteophytes and joint space narrowing in DIP2
  • milder changes in DIP4
  • severe degenerative changes with osteophytes and joint space narrowing in DIP5

Case Discussion

Findings on hand radiographs and ultrasound in keeping with erosive osteoarthritis.

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Case information

rID: 55902
Case created: 28th Sep 2017
Last edited: 3rd Oct 2017
Inclusion in quiz mode: Included
Institution: Hillel Yaffe Medical Center

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