A 51-year-old African American man with a 15-year history of chronic hepatitis C and sarcoidosis presented with persistent bilateral hand pain. The pain was aggravated by physical activity and had a waxing-and-waning pattern.
The man had an inadequate response to therapy, which included corticosteroids, methotrexate
(MTX), and hydroxychloroquine (HCQ). There was no associated rash, numbness, tingling, or weight loss.
On examination, both hands were noted to have swollen digits with bony enlargements of the proximal interphalangeal and metacarpophalangeal joints. The left index and middle fingers had
mild swan-neck deformities with signs of mild synovitis. There were no skin nodules.
Bilateral muscle strength and handgrip were intact. Bone biopsies of the patient’s right tibia, great toe, and medial malleolus were performed because there was pain and swelling in the right ankle.
X-ray films of both of his hands were obtained and are seen below.
What do they show? What is your diagnosis?
(Find the answer on the next page.)
1. Visser H, Vos K, Zanelli E, et al. Sarcoid arthritis: clinical characteristics, diagnostic aspects, and risk factors. Ann Rheum Dis. 2002;61:499-504.
2. Abril A, Cohen MD. Rheumatological manifestations of sarcoidosis. Curr Opin Rheumatol. 2004;16:51-55.