Last Week's Answer

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Congrats to Max Cruz!

When evaluating joint pain, one of the most important clinical cues if the distribution of the disease. Symmetric small joints? DIPs? PIPs? MCPs? Asymmetric large joints? Check out this AAFP Polyarticular Arthritis Review

While we do not know the distribution of his pain given our limited history, we have an Hand XR and a complaint of hand pain. If you compare the two XRs, you’ll see that there are two pretty abnormal joints: 2nd and 3rd MCPs. So what disease can cause this specific arthropathy?

Hemochromatosis

“Early lesions in consist of subchondral cysts with sclerotic margins; they may be especially notable at the metacarpal heads. Hemochromatosis may involve the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, wrists, knees, hips, feet, and shoulders. A predilection for disease in the second and third MCP joints is notable. Because of a trend of earlier diagnosis, the classic symptoms of cirrhosis, diabetes mellitus (DM), and bronze skin are seen infrequently; the most common presenting symptoms are fatigue, malaise, and joint symptoms.” (2)


This Week's Question

First Person to correctly answer (first after 5 PM on Friday) gets $5 to Starbucks!

This patient presented to your clinic with this rash.

This patient presented to your clinic with this rash.