What is the diagnosis for a patient with mild degenerative changes at the first and third metacarpophalangeal (MCP) joints on a radiograph of the right hand?

From the Guidelines

The patient's X-ray results indicate mild arthrosis at the first and third MCP joints, suggesting early hand osteoarthritis (HOA) that can be managed with conservative measures, such as over-the-counter pain medications and joint protection techniques, as supported by the EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis 1. The X-ray of the right hand taken on April 25,2025, shows mild degenerative changes (arthrosis) at the first and third metacarpophalangeal (MCP) joints, which are the knuckle joints at the base of the thumb and middle finger. There is no evidence of any acute fracture, dislocation, or significant soft tissue abnormality. The remaining joint spaces and bone alignment appear normal without significant degenerative changes. This finding represents early arthritis in these specific joints but does not indicate any acute injury requiring immediate treatment.

Key Points to Consider:

• Mild arthrosis typically develops gradually over time due to normal wear and tear, aging, or previous injuries, as suggested by the risk factors for HOA, including increasing age over 40, and joint laxity 1.
• Management may include over-the-counter anti-inflammatory medications like ibuprofen or naproxen as needed for pain, joint protection techniques, maintaining range of motion through gentle exercises, and possibly splinting if symptoms become bothersome.
• The EULAR recommendations emphasize the importance of a confident clinical diagnosis based on typical symptoms, such as pain on usage and mild morning or inactivity stiffness, especially in adults aged over 40 1.
• Functional impairment in hand OA may be significant, and function should be carefully assessed and monitored using validated outcome measures, as highlighted in the EULAR recommendations 1.
• If pain persists or worsens, follow-up with a primary care physician or hand specialist would be appropriate to discuss additional treatment options, including further imaging or blood tests to exclude coexistent disease, as recommended by the EULAR guidelines 1.

From the Research

Diagnosis and Impression

• The X-ray of the right hand shows no acute fracture or dislocation.
• There is mild degenerative change at the first and third MCP joints, indicating mild arthrosis.
• Joint spaces and bony alignment appear otherwise grossly maintained and free of significant degenerative change.
• No focal soft tissue abnormality is present.

Treatment Options for MCP Joint Arthritis

• Nonsurgical treatment options include activity modification, anti-inflammatory medications, splinting, and cortisone injections 2.
• Surgical treatment options include arthroplasty and arthrodesis, with arthroplasty being the most common treatment option for finger MCP joints 2.
• Topical anti-inflammatories such as diclofenac sodium are also a relatively newer conservative treatment option 2.
• For index finger MCP joint arthritis, treatment options include nonsurgical management with nonsteroidal anti-inflammatory drugs, splinting, occupational therapy, corticosteroid injections, and disease-modifying antirheumatic drugs, as well as operative management options such as arthrodesis and arthroplasty 3.

Management of Osteoarthritis

• The clinical management of osteoarthritis is symptomatic, with the main goals being relief of pain and improvement of function 4.
• Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are evidence-based drugs for the symptomatic relief of OA, with NSAIDs being more effective than paracetamol in some cases 4.
• The concept of short-term use of NSAIDs during flares and the use of a simple analgesic in the long term seems to be the best variant for the majority of patients with optimal benefit/risk and cost-effectiveness 4.