Maria (66 years old)

Maria is a 66-year-old retired clerk with the following medical record:

• BMI: 22
• No alcohol or tobacco consumption
• Multinodular goitre with normal thyroid function
• Pain in the hand joints for the past 8 years, without morning stiffness or past injuries/trauma

She visits your clinic reporting pain in the hand joints, worsening over time, and now impacting her daily activities. Maria informs you that she has not taken pain medications so far, and that she noticed episodes of oedema and redness, particularly bilaterally in the distal inter-phalangeal joint of the third finger.

On examination, you confirm that she has firm-bony swellings bilaterally on the posterolateral aspect of the distal inter-phalangeal joint of the third finger, with restriction in movement.

Based on your clinical judgement, Maria is diagnosed with stage 2 hand OA.