Rheumatology

Answer 2 Sclerotic erosion on a radiograph of the hand. Clinically, chronic gout can be indistinguishable from rheumatoid arthritis (RA). The joint deformities, distribution, and complications of these conditions can be identical. In general, radiographs of the hand are the most useful test to differentiate between the arthritides, particularly in cases of chronic arthritis. Erosions are seen in both RA and gout; however, in gout the erosions have sclerotic, overhanging margins, and in RA the erosions have no proliferative changes. Both the erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF) tests are nondiscriminatory because an elevated ESR can accompany all inflammatory processes, and the RF is negative in approximately 30% of patients with RA. Numbness in the index and middle fingers suggests the presence of carpal tunnel syndrome, and both gout and RA can cause carpal tunnel syndrome. Subcutaneous nodules are present in gout and RA, and if fluid cannot be withdrawn, a biopsy may be necessary. Click here to return to the questions

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