Question:medium
A patient has arthritis involving the 1st metacarpophalangeal joint, the PIP and DIP joints of the hands, while sparing the wrist and ankle. What is the most likely diagnosis?
A patient has arthritis involving the 1st metacarpophalangeal joint, the PIP and DIP joints of the hands, while sparing the wrist and ankle. What is the most likely diagnosis?
Show Hint
Which arthritis loves the DIP joints and spares the wrist?
Updated On: Jun 23, 2026
- Osteoarthritis
- Rheumatoid arthritis
- Psoriatic arthritis
- Gout
Show Solution
The Correct Option is A
Solution and Explanation
Joint-map approach: The quickest way to crack hand-arthritis questions is to ask which joints are hit and which are spared.
Reading this case: DIP and PIP joints plus the thumb base are involved and the wrist is spared. That distribution, with Heberden nodes at the DIP and Bouchard nodes at the PIP, is textbook osteoarthritis, since the DIP is the commonest OA site in the whole body.
Excluding the rest: Rheumatoid arthritis does the reverse, it loves the MCP, PIP and wrist but classically spares the DIP, so wrist sparing argues against it. Psoriatic arthritis can involve DIP joints but is given away by nail pitting, skin plaques and dactylitis, none mentioned here. Gout favours the big-toe MTP joint. So osteoarthritis is the best fit.
Reading this case: DIP and PIP joints plus the thumb base are involved and the wrist is spared. That distribution, with Heberden nodes at the DIP and Bouchard nodes at the PIP, is textbook osteoarthritis, since the DIP is the commonest OA site in the whole body.
Excluding the rest: Rheumatoid arthritis does the reverse, it loves the MCP, PIP and wrist but classically spares the DIP, so wrist sparing argues against it. Psoriatic arthritis can involve DIP joints but is given away by nail pitting, skin plaques and dactylitis, none mentioned here. Gout favours the big-toe MTP joint. So osteoarthritis is the best fit.
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