AAAAA
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How do you differentiate a rheumatoid patient (A Middle Eastern female patient 68 years old) from an osteoarthritis patient from the hand ? The patient is a female patient from Middle Eastern and according to the customs "she" does not allow you to touch her or do any physical examination except she shows you her hands. (No touching at all, and no venous puncture, no lab test, no exam of any body part !)
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| AAAAA
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Her English is very poor and she only complains of pain in the hand and she can not give you any history at all.
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| sachida
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Involvement of DIP only happens in OA
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| AAAAA
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It is very important to understand OA.
There is absolutely no such thing as diseases directly affected the elderly except osteoarthritis in which about 50% or more of the elderly are affected by osteoarthritis.
Osteoarthritis causes the formation of hard bony enlargements of the small joints of the fingers. Classic bony enlargement of the small joint at the end of the fingers is called a Heberden's node, named after a very famous British doctor. The bony deformity is a result of the bone spurs from the osteoarthritis in that joint. Another common bony knob (node) occurs at the middle joint of the fingers in many patients with osteoarthritis and is called a Bouchard's node. Dr. Bouchard was a famous French doctor who also studied arthritis patients in the late 1800s. The Heberden's and Bouchard's nodes may not be painful, but they are often associated with limitation of motion of the joint. The characteristic appearances of these finger nodes can be helpful in diagnosing osteoarthritis. Osteoarthritis of the joint at the base of the big toes leads to the formation of a bunion. Osteoarthritis of the fingers and the toes may have a genetic basis, and can be found in numerous women members of some families.
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| AAAAA
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sachida wrote:
Involvement of DIP only happens in OA
Please review OA and the statement "Involvement of DIP "ONLY" happens in OA.
O M G ! O My God !
Does OA affects the middle joint ?
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| AAAAA
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Another common bony knob (node) occurs at the "middle joint of the fingers" in many patients with osteoarthritis and is called a Bouchard's node. Dr. Bouchard was a famous French doctor who also studied arthritis patients in the late 1800s.
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| AAAAA
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In osteoarthritis affecting specific joints, the following symptoms are often seen:
In finger osteoarthritis, Heberden's nodes or enlargement in the end joints of the fingers and Bouchard's nodes or enlargement in the middle joints are seen. Although in most cases they are not painful, they can develop suddenly and become inflamed, swollen, red, and painful in a condition called nodal osteoarthritis.
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| AAAAA
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OA does not just affect the DIP !!!!
Please review this picture and it demonstrate the bony deformities of OA affecting all the joints in the hand !
Attached Files:
heberden-nodes.jpg (16 KB, 6 downloads)
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| AAAAA
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Bouchard's nodes in OA osteoarthritis are definite diagnosis of OA along with Heberden's nodes.
BOUCHARD'S NODES AFFECT THE PIP JOINTS !!!
So OA osteoarthritis does not JUST involve the DIP joints and it is important to point out the PIP joints are actually affected and Bouchard's nodes in the PIP are characteristics of osteoarthritis.
Bouchard's nodes
Bouchard's nodes are gelatinous cysts or bony outgrowths on the dorsal aspects of the proximal interphalangeal joints.
They are characteristic of nodal osteoarthritis
How to pass USMLE is that very minor difference between PIP and DIP joints.
OA affects all the small joints in the hands including the PIP and DIP joints.
But RA does not involve the DIP joints !
So it is the NEGATIVE FINDINGS OF THE DIP JOINTS INVOLVEMENT IN THE HAND TO RULE OUT RHEUMATOID ARTHITIS !
INVOLVEMENT OF THE PIP PROXIMAL JOINTS DO NOT RULE OUT OSTEOARTHITIS !!
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| AAAAA
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Boucher's nodes in the PIP joints actually point to the diagnosis of osteoarthritis.
So OA does involve the PIP joints
Attached Files:
fig4.gif (31 KB, 5 downloads)
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| AAAAA
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Dr. Boucher was the most famous French doctor in 1800 who studied osteoarthritis and found the node in the PIP joint.
Biography:
Bouchard first read medicine in Lyon, then, at the age of 25, went to Paris to continue his studies under Charcot. Bouchard was ambitious, gifted, and energetic, and, under Charcot's supervision his career pointed straight up. He became Interne des hôpitaux in 1862 and received his doctorate in 1866 in Paris with the thesis Étude sur quelques points de la pathogénie des hémorrhagies cérébrales. He became médecin du Bureau central in 1870, médecin des hôpitaux (Bicêtre) in 1874, from 1869 was professeur agrégé at the faculty, from 1879 full professor; member of the Academie de Médecine in 1886 and of the institute in 1887.
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| AAAAA
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Dr. Boucher was the most famous French doctor in 1800 who studied osteoarthritis and found the node in the PIP joint.
Biography:
Bouchard first read medicine in Lyon, then, at the age of 25, went to Paris to continue his studies under Charcot. Bouchard was ambitious, gifted, and energetic, and, under Charcot's supervision his career pointed straight up. He became Interne des hôpitaux in 1862 and received his doctorate in 1866 in Paris with the thesis Étude sur quelques points de la pathogénie des hémorrhagies cérébrales. He became médecin du Bureau central in 1870, médecin des hôpitaux (Bicêtre) in 1874, from 1869 was professeur agrégé at the faculty, from 1879 full professor; member of the Academie de Médecine in 1886 and of the institute in 1887.
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| AAAAA
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Osteoarthritis affects all the small joints in the hand and does not just affect the DIP !
And Dr. Boucher back in 1800, more than 200 years ago pointed out the PIP joint were involved in the OA patients !
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| AAAAA
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PIP involvement in the OA
Attached Files:
OsteoarthritisHand.gif (25 KB, 4 downloads)
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| AAAAA
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PIP and DIP involvement in OA
Attached Files:
heberdensTh.jpg (15 KB, 4 downloads)
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| sachida
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While AAAA you seem to read too much and post at length, you failed to read the single sentence in my answer correctly.
Your question was: "How do you differentiate a rheumatoid patient (A Middle Eastern female patient 68 years old) from an osteoarthritis patient from the hand ?" There I said : "Involvement of DIP only happens in OA"
I never said OA only involves DIP there is a difference dude. We know you are smart. But atleast read what others are saying
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| AAAAA
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sachida wrote:
While AAAA you seem to read too much and post at length, you failed to read the single sentence in my answer correctly.
Your question was: "How do you differentiate a rheumatoid patient (A Middle Eastern female patient 68 years old) from an osteoarthritis patient from the hand ?" There I said : "Involvement of DIP only happens in OA"
I never said OA only involves DIP there is a difference dude. We know you are smart. But atleast read what others are saying
Thank you very much !
WE are all here to learn !
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| guayoman
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What is the other joint NOT involved in RA?
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| AAAAA
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sachida wrote:
Involvement of DIP only happens in OA
Psoriatic arthritis also invovles the DIP joints !!
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