A 50 year-old physician experienced the abrupt onset of tenderness and swelling in the distal interphalangeal (DIP) joint of his right index finger. His only significant past medical history was Wolf-Parkinson-White syndrome, which was managed successfully with ablation. The same symptoms subsequently occurred in the DIP joints of his left index finger and fifth digits of both hands. No other digits were affected. The symptoms made it difficult for him to type on the computer. He denied trauma to the affected fingers, although he is an athlete and had had a left middle finger avulsion fracture, right middle finger dislocation, and left radial frac-ture. He had no systemic or other joint involvement.
There was no family history of connective tissue disease, psoriasis, or other arthritis conditions. The patient had no allergies, took no medication, and did not smoke cigarettes or abuse alcohol(Drug information on alcohol) or drugs.
On examination, there was swelling and tenderness of the DIP joints of the patient's index and fifth digits bilaterally. The DIP joints of both index fingers and of the right fifth digit were laterally subluxed. There was no erythema or metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint involvement, and the hand and wrist examination results were otherwise normal, as were the rest of the physical examination results. Also normal were the complete blood cell (CBC) count, 20-item chemistry panel, rheumatoid factor (RF), anticyclic citrullinated peptide (anti-CCP) antibody, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level.
A clinical photograph (top) and x-ray film (bottom) of both hands are shown.
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