Osteoarthritis
CC: Painful, stiff fingers or hand pain or problems with hands
Diagnosis:
Osteoarthritis
Differential diagnosis:
Rheumatoid arthritis
Psoriatic arthritis
Osteoarthritis
Gout
Assess activity:
Red, swollen, hot, painful hands imply active disease
Assess function:
Squeeze my finger
Pick up a coin
Pretend to use key
Ask if wheelchair, walking aid and splints
Rule psoriasis:
Nail changes
Psoriatic lesions in elbows, behind ears and scalp
Rule gout:
Ask about alcohol, diet, history of renal failure or diuretics use
Swelling small joint of hand or feet ( commonly first MTPJ )
Gout tophi ( chalky white deposits ) around joints, ear and tendons Osteoarthritis
Reduced movement & function
Rule osteoarthritis:
Heberden’s & Bouchard’s nodes at the PIJ
Carpal tunnel syndrome or scars
• Do phalen’s & tinel’s maneuvers
Disuse atrophy of hand muscle
What will you do?
Do basic profile like CBC, RFT, ..
Do ESR, CRP
Do uric acid levels
Synovial fluid for gout
Xray hand
Rheumatoid factor & anti-CCP
Management of osteoarthritis:
Weight loss
Simple analgesia
Joint replacement
Physiotherapy
Occupational therapy
