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



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