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Question

Difficulty: EasyRheumatology and Immunology

Match each classic physical examination finding with the most likely rheumatologic diagnosis.

  • Hard, bony outgrowths at the distal interphalangeal (DIP) jointsOsteoarthritis
  • Violaceous, slightly scaly papules and plaques over the metacarpophalangeal (MCP) jointsDermatomyositis
  • Diffuse, uniform swelling of a single digit with accompanying nail pittingPsoriatic arthritis
  • Symmetric MCP joint swelling with ulnar deviation and subluxationRheumatoid arthritis

Answer

Bony DIP outgrowths correspond to osteoarthritis. Violaceous knuckle plaques correspond to dermatomyositis. Diffuse digit swelling with nail pitting corresponds to psoriatic arthritis. Symmetric MCP swelling with ulnar deviation corresponds to rheumatoid arthritis.
Each rheumatologic condition has a classic physical examination signature. Osteoarthritis causes osteophyte formation (Heberden nodes at DIP, Bouchard nodes at PIP). Dermatomyositis presents with pathognomonic skin findings like Gottron papules on the knuckles. Psoriatic arthritis often involves dactylitis (sausage digits) and nail changes due to enthesitis. Rheumatoid arthritis causes erosive, symmetric synovitis leading to ulnar deviation and subluxation at the MCP joints.

Step-by-Step Solution

1
Analyze the specific joint involvement and associated dermatologic findings for each presentation.
Identified distinct patterns pathognomonic for four major rheumatologic diseases.
Pattern recognition of physical exam findings is the primary step in diagnosing and differentiating rheumatologic conditions.

Key Concept

Physical examination hallmarks in rheumatologic diseases
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Topics

Rheumatology and Immunology

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