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What's a Joint Like That Doing on a Nice Girl Like You?

Andrea Dlesk, MD
JAMA. 1987;258(2):204. doi:10.1001/jama.1987.03400020046020.
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To the Editor.—  Dr Ehrlich's1 discussion of Frans Hals' Portrait of an Elderly Lady on the cover of the Feb 20 issue was most enjoyable. As a rheumatologist, however, I would take issue with his diagnosis of interphalangeal osteoarthritis in this woman. She clearly has metacarpophalangeal joint involvement with ulnar deviation in the left hand, as well as some degree of proximal interphalangeal joint disease. There are either subcutaneous nodules or synovial cysts over the third and fourth metacarpophalangeal joints. In addition, the metacarpophalangeal joint of the right index finger appears somewhat reddened and swollen. In this hand, too, there is metacarpophalangeal joint and proximal interphalangeal joint arthropathy.In short, this woman has symmetric inflammatory polyarthropathy primarily affecting the proximal interphalangeal and metacarpophalangeal joints of both hands, in association with subcutaneous nodules. The most likely diagnosis for this patient, then, would be rheumatoid arthritis. Another possibility would be polyarticular


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