A 60-year-old patient presents with pain, stiffness, and swelling in the hand joints. Examination reveals tenderness and swelling of several of the DIP joints with the presence of Heberden’s nodes (i.e., bony outgrowths at the distal interphalangeal [DIP] joints) in a few fingers. The patient reports stiffness in the joints that worsens after using them. What feature is more indicative of osteoarthritis (OA) rather than rheumatoid arthritis (RA) in this patient?
Group of answer choices
- Morning stiffness lasting for hours
- Presence of Heberden’s nodes
- Soft and tender joint swelling
- Symmetrical involvement of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints
The correct answer is: Presence of Heberden’s nodes
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Explanation:
Heberden’s nodes are bony enlargements at the distal interphalangeal (DIP) joints, which are a hallmark feature of osteoarthritis (OA). In contrast, rheumatoid arthritis (RA) typically spares the DIP joints and instead affects the MCP and PIP joints with soft, inflammatory swelling and prolonged morning stiffness.
