Which description is most characteristic of osteoarthritis (OA) when compared to rheumatoid arthritis (RA)?

Choice A reason: Morning stiffness lasting 60 minutes or more is a hallmark of rheumatoid arthritis (RA) due to synovial inflammation in affected joints. This prolonged stiffness, worse after inactivity, reflects autoimmune-mediated synovitis, distinguishing RA from osteoarthritis. Recognizing this guides diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs) to reduce joint damage.

Choice B reason: Bamboo-shaped fingers are characteristic of psoriatic arthritis, not RA. RA causes joint deformities like swan-neck or boutonnière due to synovial destruction, not a bamboo appearance. Expecting this finding risks misdiagnosis, delaying RA-specific therapies like methotrexate, which target inflammation and prevent progressive joint erosion.

Choice C reason: Asymmetric small joint involvement is typical of osteoarthritis or psoriatic arthritis, not RA. RA features symmetric involvement of small joints, like metacarpophalangeal joints, due to systemic autoimmune inflammation. Assuming asymmetry misguides assessment, potentially overlooking RA’s bilateral pattern critical for early diagnosis and effective immunosuppressive treatment.

Choice D reason: Noninflammatory pain in large joints is not typical of RA, which involves inflammatory pain in small joints due to synovitis. Large joint pain may occur in osteoarthritis or gout. Expecting noninflammatory pain misdirects RA diagnosis, delaying interventions like corticosteroids or biologics to manage inflammation and joint destruction.

Choice A reason: Complications of immobility, like muscle atrophy or thromboembolism, occur with both ORIF and closed reduction, as both may require immobilization post-procedure. ORIF involves surgery, but modern protocols emphasize early mobilization, similar to closed reduction. This disadvantage is not unique to ORIF, making it an incorrect choice.

Choice B reason: ORIF involves surgical incision and hardware placement, increasing infection risk at the surgical site or deep tissues (osteomyelitis). Closed reduction is non-invasive, avoiding this risk. Infections can delay healing, require antibiotics, or necessitate hardware removal, making this a significant disadvantage of ORIF compared to closed reduction.

Choice C reason: Skin irritation can occur with both ORIF (from incisions or hardware) and closed reduction (from casts or splints). It is not a distinct disadvantage of ORIF, as both methods involve external or internal devices that may irritate skin. This choice is incorrect, as it is not unique to ORIF.

Choice D reason: Nerve impairment risks exist in both ORIF (from surgical manipulation) and closed reduction (from fracture displacement or cast pressure). Neither method uniquely predisposes to nerve damage, and careful technique minimizes this risk. This disadvantage is not specific to ORIF, making it an incorrect choice.