Osteoarthritis

Question · easy

A 64-year-old woman with a BMI of 31 kg/m² reports 8 months of bilateral knee pain that worsens when climbing stairs and eases with rest. Morning stiffness lasts about 15 minutes. Examination shows crepitus and joint-line tenderness at both knees without effusion, warmth, or erythema. Which is the most appropriate initial management?

Glucosamine-chondroitin sulfate supplementation Oral prednisone taper and rheumatology referral Arthroscopic debridement and lavage Weekly intra-articular hyaluronic acid injections Structured exercise program and weight loss

Question · easy

A 70-year-old woman has bony enlargement of the distal interphalangeal joints of both hands, present for years and only mildly achy. These findings are best termed:

Rheumatoid nodules Heberden nodes Tophi Osteophytes of the metacarpophalangeal joints Bouchard nodes

Question · medium

A 52-year-old man reports progressive pain and stiffness of both hands. Radiographs show joint-space narrowing and osteophytes predominantly at the second and third metacarpophalangeal joints, with relative sparing of the DIP and PIP joints. In addition to analgesia, which evaluation is most important?

HLA-B27 typing Serum iron studies (ferritin and transferrin saturation) Dual-energy CT for urate deposition Serum uric acid and 24-hour urine calcium Anti-cyclic citrullinated peptide antibody and rheumatoid factor

Question · medium

A 67-year-old man with chronic medial knee OA pain has an MRI obtained by his primary physician showing a degenerative medial meniscal tear. He has no locking, buckling, or acute injury. He asks whether arthroscopic partial meniscectomy will fix the problem. The best response is that arthroscopic surgery:

Should be combined with arthroscopic lavage, which adds proven benefit Provides no better outcomes than conservative management unless there is true joint locking, buckling, or instability Is the preferred next step before attempting physical therapy Is indicated because the tear is visible on MRI Is indicated only if hyaluronic acid injections fail first

Question · hard

A 42-year-old woman reports 9 months of widespread pain (12 of 19 body regions), severe fatigue, and nonrestorative sleep. WPI is 12 and Symptom Severity Scale score is 9. ESR and CRP are normal; ANA is positive at 1:160. She is anxious that she has lupus. Which is the most appropriate management?

Start hydroxychloroquine empirically for possible early SLE Order an extended autoimmune panel (anti-dsDNA, anti-Smith, complements) before any diagnosis is made Start prednisone 20 mg daily and arrange rheumatology follow-up Perform a 18-point tender-point examination to confirm fibromyalgia before treating Diagnose fibromyalgia by validated symptom criteria, educate and reassure, and begin a graded aerobic exercise program