Differentiating Bilateral Symptomatic Hand Osteoarthritis From Rheumatoid Arthritis Using Sonography When Clinical and Radiographic Features Are Nonspecific: A Case Report.

OBJECTIVE

The purpose of this report is to describe a patient with bilateral symptomatic hand osteoarthritis (OA) originally thought to be rheumatoid arthritis (RA) based on clinical and radiographic features.

CLINICAL FEATURES

A 48-year-old woman presented with bilateral hand pain, stiffness, swelling, and redness in the proximal and distal interphalangeal joints of 1 year's duration. Laboratory analysis and plain film radiography were equivocal. These findings necessitated the use of diagnostic ultrasound, which revealed no synovitis or erosions in the joints of the hand, so a diagnosis of bilateral symptomatic hand OA was rendered.

INTERVENTION AND OUTCOME

A trial of conservative care consisting of mobilizations, instrument-assisted soft tissue therapy, and laser therapy was given. At 1-month follow-up, the patient regained full pain-free range of motion and strength and returned to complete work activity.

CONCLUSION

This case report demonstrated that hand OA can present with nonspecific inflammatory-like clinical features. These findings require further testing, in which case ultrasound imaging may be valuable to differentiate OA from RA. Using ultrasound to make this diagnosis may guide management, with rheumatology referral for RA and conservative care for OA.