Rheumatoid arthritis (with mild ulnar deviation of metacarpophalangeal goints and buchard's nodes on middle an ring finger.)
Differentials 1) Rheumatoid arthritis with rheumatoid nodules ( nodules are sometimes brought on or made worse after starting RX with methotrxate ) 2) This could also be tophaceous gout as well ( with severe affliction of the joints, it can deviate and mimic the external appearance of Rheumatoid arthritis ) The ext. appearance of tophi and rheumatoid nodules can look similar early on. With time the skin overlying the tophaceous gout will tend to become inflamed and ulcerate....Why ? becos, the neutrophils that r attracted to that area will devour the needle shaped crystals. These needles will then needle thru the lysosome and make the neutrophils pour their guts out..leading to the inflammation.
My diagnosis is mixed picture: rheumatoid arthritis with osteoarthritis My reasoning is - RA: ulnar deviation, MCP & proximal IPJ affected (with sparing of DIPJ) - 2,3,4th fingers OA: 4th DIP has some mass, likely Heberdens; possible the PIP could be Bouchards or rheumatoid nodule Happy to be corrected, and advised either way
I would bet more for a tophaceous gout because of the aspect of indexfinger indexinterphalangeal joint, the affextion seems to exeed the articulation and seem to affect the soft tissue we must see the anamnestic too, did he have gout crisis antecedent?
