Review Question - QID 106264

This man has classic findings of osteoarthritis, which is characterized by DIP joint osteophyte/nodule formation.

Osteoarthritis is a disease of chronic wear that ultimately results in the destruction of articular cartilage and the formation of subchondral bone and osteophytes. Weight-bearing joints, such as the back and hips are most commonly affected, as in this case. Unlike rheumatoid arthritis, the symptoms of osteoarthritis worsen throughout the day and are more commonly seen at the DIP joints.

Sinusas describes the risk factors, diagnosis, and treatment of osteoarthritis. Genetics, female sex, trauma, advancing age, and obesity predispose patients to osteoarthritis, the diagnosis of which is based largely on a history of joint pain worsened by movement that affects activities of daily living. Pharmacologic treatment should begin with acetaminophen and progress to nonsteroidal anti-inflammatory drugs if necessary. It might seem counter-intuitive, but exercise/physical therapy is a useful adjunct to treatment and has been shown to reduce pain and disability.

McHughes and Lipman describe alternative therapies to NSAIDs, opioids, and surgery for the management of osteoarthritis, which include tramadol and intra-articular injections of steroids and hyaluronic acid. There is evidence to support the familiar over-the-counter nutraceutical glucosamine as an adjunct in treating osteoarthritis; however, evidence is lacking to support the use of chondroitin, S-adenosyl-methionine, or dimethyl sulfoxide in osteoarthritis pain management. Some patients choose to pursue these drugs despite the absence of evidence with mixed reviews.

Figure A shows the classic bony enlargements of the DIP joints, known as Heberden's nodes.

Illustration A shows an x-ray of a hand with the classic findings of osteoarthritis including osteophyte formation, subchondral bone deposition and joint space narrowing.

Incorrect Responses:
Answer 1: Gout results in the painful swelling of a joint, most commonly the metatarsophalangeal joint that results from precipitation of monosodium urate crystals.
Answer 2: Pseudogout is similar to gout, but results from precipitation of calcium pyrophosphate crystals.
Answer 3: Rheumatoid arthritis is an autoimmune inflammatory disorder that most commonly affects the PIP joints. The symptoms of rheumatoid arthritis often improve throughout the day.
Answer 5: Osteopenia is the loss of bone density secondary to hormone-related calcium resorption that is especially common in postmenopausal women. It is otherwise asymptomatic but can predispose patients to fractures.