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motion in the joints. The form of osteoarthritis depends on the joints involved. Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. One of the joints that are frequently involved is the distal interphalangeal joint of the hands. Progressive enlargement of these joints is termed Heberden's nodes. As the disease progresses, the proximal interphalangeal joints may become involved, resulting in Bouchard's nodes. Figure 20-59 shows the hands of a woman with osteoarthritis.

Gout is a metabolic disease characterized by high levels of uric acid, recurrent attacks of acute arthritis, and deposition of urate crystals in and around the joints. The initial manifestation is frequently acute pain in the first metatarsophalangeal joint, often waking the patient from sleep. Even at rest, the pain is severe, but the slightest movement of the joint is agonizing. Within a few hours, the joint becomes swollen, shiny, and red. The higher the level of uric acid, the more likely the patient is to develop tophi, which are subcutaneous and periarticular deposits of urate crystals. The commonly involved sites are over the first metatarsophalangeal joint, the finger, the ear, the elbow, and the Achilles tendon. Figure 20-60 shows a gouty deposit on the big toe. Figure 20-61 shows the arms of a patient with chronic tophaceous gout who has large tophi on her elbows, as well as smaller tophi on her hands. Tophi frequently develop over the distal interphalangeal joints of the fingers and in the olecranon and prepatellar bursae. Figure 20-62 shows the hands of a patient with tophi on her fingers.

As discussed in Chapter 8, The Skin, psoriasis is one of the most common skin diseases in the United States. The pustular variant is characterized by pustules localized to the palms and soles. The patient may be quite ill, with fever and leukocytosis. Figure 20-63 shows pustular psoriasis of the soles. Note the hyperkeratosis on an erythematous base.

Joint disease develops in approximately 7% of patients with psoriasis. The most common form of psoriatic arthritis (70%) is asymmetric arthritis involving only two or three joints at a time. Arthritis mutilans is the most deforming type of psoriatic arthritis. In the most severe cases, there is osteolysis of the phalangeal and metacarpal joints, resulting in ''telescoping of

Figure 20-62 Gout. Note tophi on the fingers.

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Osteoarthritis

Osteoarthritis

Thank you for deciding to learn more about the disorder, Osteoarthritis. Inside these pages, you will learn what it is, who is most at risk for developing it, what causes it, and some treatment plans to help those that do have it feel better. While there is no definitive “cure” for Osteoarthritis, there are ways in which individuals can improve their quality of life and change the discomfort level to one that can be tolerated on a daily basis.

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