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Discussion Starter · #1 ·
A 68-year-old woman comes to the office because of pain and stiffness in her both hands for the last three years, which tends to get worse at the end of the day or after gardening. The patient had a history of complicated bleeding peptic ulcer and so she stopped taking Aspirin and is only taking acetaminophen and lansoprazole. She claims that Acetaminophen is no longer controlling her pain. On examination, you noted several hard painless nodules on the dorsolateral surfaces of the distal interphalangeal joints. No joint erythema or swelling noted. Other systems were within normal limits. Which of the following is true regarding this patient's arthritis?

A- Antinuclear antibody and/or Rheumatoid factor are likely to be positive
B- Endomethacin should be tried
C- Aspiration of one of the nodules should be performed
D- The patient is likely to be HLA B27 positive
E- A trial of celecoxib maybe tried
F- A trial of rofecoxib maybe tried
 

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Discussion Starter · #2 ·
Heberden's nodes described here. This is OA and you'd definitely start a COX 2 inhibitor.
Rofecoxib has been taken out from the US market in 2004.
So the correct answer is E
 

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i think we do - Aspiration of one of the nodules because it is not definetly osteoarthritis and be in my differential diagnosis and also may be gouty arthritis and causes these nodules
 

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Discussion Starter · #4 ·
i think we do - Aspiration of one of the nodules because it is not definetly osteoarthritis and be in my differential diagnosis and also may be gouty arthritis and causes these nodules
Gouty arthritis does not present with symmetircal bilateral polyarticular patterns such as this case. Also the case mentioned not erythema or swelling and so it's very unlikely to be gout. Also it mentions that the pain and stiffness get worse with use of the joints which is a typical history seen in osteoarthritis.
 
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