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

George E. Ehrlich, MD
JAMA. 1987;258(2):204. doi:10.1001/jama.1987.03400020046021.
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In Reply.—  Dr Dlesk is indulging in the delightful game of diagnosis from clues in art, which I have also played.1 However, one should look at the actual picture rather than a reproduction to be sure that the clues lead in the right direction, and one must also consider stylistic variations to help explain what one sees. In my short discussion of the Portrait of an Elderly Lady by Frans Hals, I took pains to point out that I believed Hals was following the stylistic convention rather than depicting disease.I did state that a physician attempting to make a diagnosis would see interphalangeal osteoarthritis. I see no reason to change that diagnosis because of supposed metacarpophalangeal joint involvement, and certainly not because of synovial cysts or other lumpiness of the joints, or even signs of inflammation. These are all hallmarks of inflammatory interphalangeal osteoarthritis,2 which is frequently


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