Arthritis of the Hand - Arthritis Patterns Osteoarthritis: • Osteoarthritis of the hand usually involves the DIP and PIP joints, but not the metacarpophalangeal (MCP) joints. • Bouchard's nodes - PIP • Heberden's nodes - DIP • XRAY: joint-space narrowing, subchondral sclerosis, and osteophytes Rheumatoid Arthritis: • Rheumatoid arthritis of the hand most often involves the PIP and MCP joints, but not the DIP joints. • 2nd and 3rd MCP and PIP joints commonly involved • Boutonnière deformity • Swan neck deformity Psoriatic Arthritis: • Pencil in cup • Arthritis mutilans • Dactylitis Jaccoud's Arthropathy: • (MCP) subluxation causing ulnar deviation • SLE - 5% of times Joint Involvement Patterns: • PIP + DIP + 1st CMC = OA • MCP + PIP + Wrist = RA • 2nd & 3rd MCP + hook like osteophytes = Hemochromatosis • Wrist + 2nd MCP + 2nd PIP + all DIP = PsA • Dactylitis/Sausage digits = PsA, Sickle cell anemia, Polyarticular gout, Sarcoidosis • Psoriatic arthritis, crystal-induced arthritis, and sarcoidosis - affect all of these joints Miscellaneous Entities Mimicking Hand Arthritis: • RS3PE (Relapsing seronegative symmetric synovitis with pitting edema) • PVNS (Pigmented villonodular synovitis) • Thyroid acropachy • HOA • Vit A toxicity • Voriconazole induced periostitis • CRPS/Causalgia • Charcot arthropathy #Arthritis #patterns #hand #diagnosis #rheumatology #inflammatory
