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1mo ago
How to separate rheumatoid arthritis from osteoarthritis on the USMLE in seconds.
The NBME rarely makes this a lab question first. It's a pattern question. Joint distribution and stiffness timing get you there.
Rheumatoid arthritis: autoimmune and inflammatory. Symmetric MCP, PIP, and wrist involvement. DIPs spared. Morning stiffness over an hour that improves with use. Systemic symptoms. Anti-CCP is the most specific antibody. X-ray shows erosions and periarticular osteopenia. Watch for ulnar deviation, swan neck, boutonnière, and C1–C2 instability before intubation.
Osteoarthritis: mechanical. DIP (Heberden nodes), PIP (Bouchard nodes), and weight-bearing joints. MCPs spared. Brief stiffness that worsens with activity. No systemic symptoms. X-ray shows osteophytes, subchondral sclerosis, and subchondral cysts.
From Rahul Damania, MD, pediatric critical care physician and Faculty Editor for First Aid for the USMLE Step 1.
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