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Discussion in 'Spot Diagnosis' started by bb100, Mar 9, 2013.

  1. bb100

    bb100 Bronze Member

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    what is the most likely diagnosis?

    22.jpg
     

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  2. Rosita

    Rosita Active member

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    Rheumatoid arthritis (with mild ulnar deviation of metacarpophalangeal goints and buchard's nodes on middle an ring finger.)
     

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  3. neo_star

    neo_star Moderator

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    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.
     

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  4. apparat

    apparat Well-Known Member

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    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
     

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  5. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

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  6. lepersan

    lepersan Active member

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    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?
     

  7. dupuytren

    dupuytren Bronze Member

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    tophaceous gout
     

  8. bb100

    bb100 Bronze Member

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    Correct Answer :tophaceous gout
     

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