Question

An elderly patient with the following deformity was brought to the OPD. What is the most probable diagnosis?

• A. Rickets
• B. Osteomalacia
• C. Osteoarthritis
• D. Rheumatoid arthritis

Hint:

Rheumatoid arthritis should be suspected in elderly patients with symmetrical joint involvement, morning stiffness, and characteristic joint deformities. Early diagnosis and treatment can help prevent long-term disability.

Answer 1

The Correct Option is D

The deformity seen in the image is more consistent with Rheumatoid arthritis (RA), a chronic autoimmune disorder that primarily affects the joints. It is characterized by:
Symmetrical joint involvement: RA typically affects joints on both sides of the body, such as the wrists, knees, and fingers.
Joint deformities: In advanced cases, RA leads to deformities such as ulnar deviation of the fingers, swan neck deformities, and boutonniere deformities. These deformities result from chronic inflammation of the joints and tendons.
Morning stiffness: One of the hallmark features of RA is prolonged morning stiffness that improves with movement.
Differential diagnoses:
Rickets: This condition is caused by vitamin D deficiency in children, leading to bone deformities, particularly in the legs, and would not present in elderly patients with such joint involvement.
Osteomalacia: Similar to rickets, but it occurs in adults due to vitamin D deficiency. It causes soft bones but does not typically result in the joint deformities seen in RA.
Osteoarthritis: OA usually affects the elderly but tends to involve asymmetrical joint involvement and is typically associated with bone spurs and joint space narrowing rather than the soft tissue inflammation seen in RA. Therefore, the correct diagnosis is Rheumatoid arthritis, as the deformities and the clinical picture match this autoimmune condition.