A 48-year-old man presents with chronic pain and stiffness of the second and third metacarpophalangeal joints of both hands. Radiographs show joint space narrowing with prominent hook-shaped osteophytes arising from the radial aspect of the metacarpal heads, along with chondrocalcinosis of the triangular fibrocartilage. Fasting blood glucose is 138 mg/dL. Which metabolic disorder best explains these findings?

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

Explanation

Hemochromatotic arthropathy characteristically involves the second and third metacarpophalangeal joints, with hook-like beak osteophytes on the radial side of the metacarpal heads, and is frequently associated with calcium pyrophosphate deposition and chondrocalcinosis. Impaired glucose tolerance supports iron overload affecting the pancreas. Primary hyperparathyroidism causes chondrocalcinosis but spares the distinctive MCP hook osteophytes, and ochronotic arthropathy targets the lumbar spine and large joints rather than the second and third MCP joints.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.