Answer |

^*Varsha Yadav,

^*Post Graduate Resident, Department Of Medicine Lady Hardinge Medical College, New Delhi

A 48-year-old female presented with complaints of intermittent pain in the small joints of her hands and a painful right knee that has been progressively worsening over the past year. The pain exacerbated with movement and was only partially relieved with rest. She did not experience any fever or morning stiffness. Additionally, she did not report any associated symptoms such as rashes, oral ulcers, or sensitivity to sunlight.

During examination, the patient had a BMI of 26. The affected joints, including the distal interphalangeal (DIP), proximal interphalangeal (PIP), and first carpometacarpal joints, exhibited tenderness over joint line upon palpation. Heberden and Bouchard deformities were also noted (Figure). X-ray of the affected joints was suggestive of narrowed joint spaces, subchondral sclerosis and marginal osteophytes.

Based on these findings, a diagnosis of osteoarthritis was established.

DISCUSSION

Osteoarthritis, the most common type of arthritis, is a chronic condition that mainly affects middle-aged and older adults. It leads to the breakdown of joint cartilage and typically impacts areas like the hands, knees, hips, or spine, while sparing joints like the ankle, elbow, wrist, and MCP joints. [1] It can be categorized as primary, with no known cause, or secondary, resulting from other factors such as connective tissue disorders, infections, injuries, or deformities. Risk factors for developing OA include age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities)[2]

Classic physical exam findings in hand osteoarthritis include Heberden’s nodes (swellings at the back of the DIP joints), Bouchard’s nodes (swellings at the back of the PIP joints), and “squaring” at the base of the thumb (first CMC joints). X-rays can reveal features consistent with osteoarthritis, such as marginal osteophytes, joint space narrowing, subchondral sclerosis, and cysts. [2, 3]

Non-pharmacologic therapies are crucial for managing osteoarthritis and involve avoiding activities that worsen pain, exercising to strengthen muscles, weight management, and occupational therapy aimed at unloading joints using braces, splints, canes, or crutches. Additionally, pain and swelling can be relieved with the use of analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs). [3, 4]

REFERENCES

1. Bortoluzzi A, Furini F, Scirè CA. Osteoarthritis and its management – Epidemiology, nutritional aspects and environmental factors. Autoimmun Rev. 2018; 17(11):1097-1104.

2. Miller A, Lutsky KF, Shearin J, Cantlon M, Wolfe S, Beredjiklian PK. Radiographic Patterns of Radiocarpal and Midcarpal Arthritis. J Am Acad Orthop Surg Glob Res Rev. 2017; 1(3):e017.

3. Berenbaum F, Wallace IJ, Lieberman DE, Felson DT. Modern-day environmental factors in the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2018; 14(11):674-681.

4. Donahue SW. Krogh’s principle for musculoskeletal physiology and pathology. J Musculoskelet Neuronal Interact. 2018; 18(3):284-291.