Bone Ache and Stiffness

4. A 62-year-old woman was concerned about her fingers, which weren’t straight. She’d had increasing pain in both hands (specifically the metacarpophalangeal [MCP] joints) over the past 2 years. Her fingers were stiff in the morning, but she was able to gain some relief with ibuprofen and naproxen. On physical exam, her fingers had an ulnar deviation and there was swelling of the MCP joints on both hands.

Diagnosis: Rheumatoid arthritis (RA) was diagnosed, based on the patient’s bilateral MCP joint swelling, ulnar deviation, and morning stiffness. Patients with RA initially experience swelling and stiffness in their wrists, as well as their MCP and metatarsophalangeal joints. Later, the larger joints are affected. When RA is advanced, severe destruction and subluxation occur.

“Crooked fingers.” J Fam Pract. 2015.

Photo courtesy of Dr. Richard Usatine, MD. The case was adapted with permission from Chumley H, Usatine R. Arthritis overview. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:562-568.

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