Primary hand osteoarthritis favours the distal and proximal interphalangeal joints and the thumb base. Bony enlargement, joint-space loss or hook-like osteophytes at the second and third metacarpophalangeal joints should prompt a search for a cause.
The usual suspects are haemochromatosis, calcium pyrophosphate deposition and repetitive manual work. Check iron studies, calcium, magnesium, phosphate and alkaline phosphatase, and consider HFE genotyping and a hand radiograph looking for chondrocalcinosis.
- Examine and image the second and third MCP joints specifically
- Check iron studies, calcium, magnesium, phosphate and alkaline phosphatase
- Look for chondrocalcinosis on hand and knee radiographs
- Ask about occupation and heavy manual use of the hands
Why it matters
The joint pattern is often the first clue to a treatable metabolic disease.
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