A 45-year-old man presents with chronic pain and stiffness of the second and third metacarpophalangeal joints bilaterally. Radiographs show joint space narrowing with distinctive hook-like osteophytes on the radial aspect of the metacarpal heads, along with punctate chondrocalcinosis of the triangular fibrocartilage. The underlying metabolic disorder to investigate is:

• A Wilson disease
• B Hereditary hemochromatosis ✓
• C Ochronosis (alkaptonuria)
• D Primary hyperparathyroidism

Explanation

Hemochromatosis arthropathy characteristically involves the second and third metacarpophalangeal joints, shows hook-like beak osteophytes on the metacarpal heads, and is frequently associated with calcium pyrophosphate deposition. Wilson disease causes degenerative change in large joints, ochronosis targets the spine and large joints with dense disc calcification, and hyperparathyroidism produces subperiosteal resorption rather than this pattern.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.