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September 2003
By Theodore E. Keats, MD
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A 57-year-old woman complains of longstanding pain
in both hands. What is your interpretation of the frontal
view of her hands?
CLICK HERE FOR ANSWER
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ANSWER
The correct diagnosis is erosive osteoarthritis. Note
the loss of articular cartilage in the proximal and
distal interphalangeal joints and the intra-articular
erosion in many of the joints. There are also some rather
common degenerative changes at the bases of the first
metacarpals. Erosive osteoarthritis is a disease of
postmenopausal women and differs from the classic degenerative
arthritis, which most often affects the distal interphalangeal
joints and is not associated with erosions. The erosive
variant can lead to ankylosis of the involved joints
and may be confused with rheumatoid arthritis.
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This series of diagnostic quizzes that
challenge your ability to read a variety of x-ray films is
edited by Dr. Keats, professor of radiology and professor
of orthopedics at the University of Virginia School of Medicine
in Charlottesville.
Emerg Med 35(9):63, 2003
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