A 35-year-old woman presents with wrist pain and swelling. Radiographs show periarticular osteopenia, uniform joint space narrowing of the radiocarpal and intercarpal joints bilaterally, and erosions at the ulnar styloid process. What is the most likely underlying diagnosis?

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

Explanation

Rheumatoid arthritis is a synovitis-driven inflammatory arthropathy with characteristic plain film findings: periarticular osteopenia due to hyperaemic synovium, symmetrical uniform joint space narrowing (pannus erodes cartilage uniformly throughout the joint), marginal erosions at bare areas (sites where synovium is not covered by cartilage), and bilateral symmetric distribution. The wrist is the most commonly affected joint, with early involvement of the ulnar styloid and distal radioulnar joint. Gout produces juxta-articular erosions with overhanging edges and preserved joint space. Osteoarthritis shows osteophytes, subchondral sclerosis, and non-uniform narrowing. Psoriatic arthritis often spares the wrist and shows a ray distribution.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.