A 62-year-old woman presents with pain and stiffness in both hands. Examination reveals bony swellings at the distal interphalangeal joints and the first carpometacarpal joints. The metacarpophalangeal joints are normal. The most likely diagnosis is:

• A Rheumatoid arthritis
• B Gout
• C Psoriatic arthritis
• D Osteoarthritis ✓

Explanation

Osteoarthritis characteristically involves the distal interphalangeal joints (Heberden's nodes), proximal interphalangeal joints (Bouchard's nodes), and the first carpometacarpal joint, while sparing the metacarpophalangeal joints. Rheumatoid arthritis typically affects the metacarpophalangeal and proximal interphalangeal joints, sparing the distal interphalangeal joints. Psoriatic arthritis often involves the distal interphalangeal joints but is usually asymmetric and associated with nail changes. Gout is an acute monoarthritis, not a chronic symmetric polyarthritis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.