Question
A 28-year old woman complains of arthritis involving bilateral metacarpophalangeal, proximal interphalangeal and wrist joints of one year duration. The most likely disease entity is:
The correct answer is
Rheumatoid arthritis
Diagnosis of Arthritis: Key Joint Findings
The patient presents with arthritis affecting bilateral metacarpophalangeal (MCP), proximal interphalangeal (PIP), and wrist joints for one year. Key factors include age (28 years), joint distribution (small joints of hands and wrists), symmetry (bilateral), and duration (chronic).
Differential Diagnosis Evaluation
- Systemic lupus erythematosus (SLE): While SLE can cause arthritis in similar joints, it typically involves other systemic symptoms not mentioned. The arthritis is often migratory.
- Ankylosing spondylitis (AS): Primarily affects the spine and sacroiliac joints. Peripheral arthritis is less common and usually involves larger joints.
- Rheumatoid arthritis (RA): Characteristically presents as a symmetrical, chronic inflammatory arthritis affecting the MCP, PIP, and wrist joints. This pattern is highly suggestive in a young adult.
- Osteoarthritis (OA): More common in older individuals and typically affects DIP joints, the base of the thumb, and spine. MCP and PIP involvement is less typical for OA.
Conclusion
Given the symmetrical involvement of bilateral MCP, PIP, and wrist joints in a 28-year-old woman over a one-year duration, Rheumatoid arthritis is the most likely diagnosis.
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Important Questions from Arthritis
- Which of the following statements regarding Ankylosing spondylitis (AS) are true?
1. AS occurs in about 10 % of Inflammatory Bowel Disease(IBD) patients
2. The AS activity is related to Bowel activity in IBD patients
3. The AS activity does remit with glucocorticoids or colectomy in IBD patients
Select the correct answer using the code given below: - Which of the following statements about “Early onset Osteoarthritis” are true?
1. Onset is usually before the age of 55 years
2. There is clear history of previous trauma
3. In most cases, single joint is affected
Select the correct answer using the code given below: - A 31-year young man presents with fever, weight loss, pain with swelling of knee joint and low backache with stiffness. Three weeks earlier, he was treated for symptoms of urinary tract infection by local practitioner. The joint aspirate is leucocyte rich and contains multinucleated macrophages. His urine culture is sterile. What is the most probable diagnosis?
- Consider the following statements regarding Gout in old age.
1. Most of older patients have gout secondary to diuretic use and chronic kidney disease
2. Joints of the upper limbs are more frequently affected
3. Presentation is typical with acute attack of gout
Which of the statements given above are correct? - Which of the following are the complications of Rheumatoid arthritis?
1. Peripheral entrapment neuropathies
2. Subluxation of the cervical spine at the atlanto-axial joint
3. Primary amyloidosis
4. Lymphoma
Select the correct answer using the code given below:
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