Match each clinical presentation involving the hands and joints to the most likely rheumatologic diagnosis.
- A 42-year-old man with asymmetric oligoarthritis, dactylitis, and radiographic evidence of erosions with bone proliferation at the distal interphalangeal jointsPsoriatic arthritis
- A 65-year-old woman with chronic hand pain that worsens with use, squaring of the first carpometacarpal joint, and palpable bony nodules at the distal interphalangeal jointsOsteoarthritis
- A 40-year-old woman with progressive proximal muscle weakness and violaceous, scaly plaques symmetrically distributed over the metacarpophalangeal and interphalangeal jointsDermatomyositis
- A 50-year-old woman with symmetric polyarthritis of the hands, morning stiffness lasting 2 hours, and fixed ulnar deviation of the metacarpophalangeal jointsRheumatoid arthritis
- A 48-year-old woman with long-standing Raynaud phenomenon, esophageal dysmotility, and skin thickening restricted to the fingers and handsLimited cutaneous systemic sclerosis
Answer
The correct matches link dactylitis and distal interphalangeal joint erosions to psoriatic arthritis; Heberden nodes and first carpometacarpal squaring to osteoarthritis; proximal weakness and Gottron papules to dermatomyositis; symmetric polyarthritis with ulnar deviation to rheumatoid arthritis; and Raynaud phenomenon with sclerodactyly to limited cutaneous systemic sclerosis.
Each clinical presentation highlights high-yield manifestations of specific rheumatologic diseases affecting the hands. Diagnosis relies on combining joint distribution (e.g., distal vs. proximal), the character of stiffness (inflammatory vs. non-inflammatory), and unique cutaneous or radiographic findings (Gottron papules, sclerodactyly, dactylitis).
Step-by-Step Solution
Key Concept
Clinical presentation and joint distribution of rheumatologic diseases