Question:
A patient has arthritis involving the 1st metacarpophalangeal joint, the PIP and DIP joints of the hands, while sparing the wrist and ankle. What is the most likely diagnosis?
A patient has arthritis involving the 1st metacarpophalangeal joint, the PIP and DIP joints of the hands, while sparing the wrist and ankle. What is the most likely diagnosis?
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Which arthritis loves the DIP joints and spares the wrist?
Updated On: Jun 23, 2026
- Osteoarthritis
- Rheumatoid arthritis
- Psoriatic arthritis
- Gout
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The Correct Option is A
Solution and Explanation
Answer: Osteoarthritis.
Step 1: The pattern here is small-joint hand disease involving the DIP and PIP joints and the first carpometacarpal/MCP region, while sparing the wrist and ankle.
Step 2: The DIP joint is the single most common site in the body for osteoarthritis, where it produces Heberden nodes. The PIP (Bouchard nodes) and the base of the thumb are also classic OA sites.
Step 3: Rheumatoid arthritis characteristically involves the MCP and PIP joints and the wrist and spares the DIP joints, which is the opposite of this case. Psoriatic arthritis can hit DIP joints but usually comes with nail and skin changes and dactylitis. Gout typically starts in the first MTP joint of the great toe, not this hand pattern.
Step 4: DIP involvement with wrist sparing fits osteoarthritis best. Ref: Harrison's Principles of Internal Medicine.
Step 1: The pattern here is small-joint hand disease involving the DIP and PIP joints and the first carpometacarpal/MCP region, while sparing the wrist and ankle.
Step 2: The DIP joint is the single most common site in the body for osteoarthritis, where it produces Heberden nodes. The PIP (Bouchard nodes) and the base of the thumb are also classic OA sites.
Step 3: Rheumatoid arthritis characteristically involves the MCP and PIP joints and the wrist and spares the DIP joints, which is the opposite of this case. Psoriatic arthritis can hit DIP joints but usually comes with nail and skin changes and dactylitis. Gout typically starts in the first MTP joint of the great toe, not this hand pattern.
Step 4: DIP involvement with wrist sparing fits osteoarthritis best. Ref: Harrison's Principles of Internal Medicine.
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