Medical Analysis Report

1. Imaging Findings

Based on the provided X-ray images of the hands and feet, the following characteristics can be noted:

• Both hands: Multiple joint space changes, especially in the distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joints. Erosive lesions are observed, showing irregular joint surfaces, locally widened joint spaces, and even destructive changes.
• Both wrist joints: Mild joint space changes with signs of localized soft tissue swelling.
• Both feet: Mild to moderate joint space changes, particularly at the metatarsophalangeal joints, with irregular erosive changes of the joint surfaces. Slight soft tissue swelling may be present.
• No obvious signs of osteopenia or typical calcification changes are observed. Bone spurs (osteophytes) are not evident.
• Overall, the findings suggest symmetrical, multi-joint erosive changes mainly concentrated at the joint margins, possibly leading to destruction of the joint surfaces.

2. Potential Diagnoses

Considering the patient’s age, medical history (including ulcerative colitis), and the multi-joint erosive changes shown on imaging, the primary differential or potential diagnoses are as follows:

1. Multicentric Reticulohistiocytosis (MRH)
   Characterized by the involvement of both skin and joints, with significant erosive destruction, commonly affecting distal interphalangeal joints. Skin nodules or papules may appear. Imaging typically shows symmetrical, multi-joint erosions without marked osteopenia, and severe joint damage can occur.
2. Rheumatoid Arthritis
   Usually presents with prolonged morning stiffness and multi-joint involvement, often symmetrical erosions primarily in the PIP and MCP joints. It less commonly shows such prominent involvement of the DIP joints. Pronounced soft tissue swelling and potential osteopenia are often present.
3. Psoriatic Arthritis
   Clinically, it may involve DIP joints and can show peri-nail lesions. However, imaging findings are often “asymmetric” erosions and may feature the “pencil-in-cup” deformity. It can be further differentiated by typical cutaneous psoriasis features.
4. Erosive Osteoarthritis (Erosive OA)
   Typically affects DIP and PIP joints in postmenopausal or elderly women. It manifests as joint space narrowing and erosive damage to cartilage. The formation of confluent osteophytes is more common, and the distributions tend to be localized rather than widespread symmetrical erosions.

3. Final Diagnosis

Considering the following:

• The patient is a middle-aged female with a history of ulcerative colitis.
• Skin manifestations: Red papules on the face and chest.
• Joint symptoms: Erosive arthritis involving the DIP, PIP, MCP, and wrist joints, showing symmetrical and concurrent destruction.
• Imaging findings: Multi-joint erosive changes without significant osteopenia or exostosis.
• Histopathology: Tissue biopsy reveals histiocytic proliferation consistent with MRH.

The most likely diagnosis is Multicentric Reticulohistiocytosis (MRH). For further precise typing or to assess other potential complications, additional imaging or biopsy may be required to rule out any associated malignancies.

4. Treatment Plan and Rehabilitation

Given the rarity and progression rate of MRH, early intervention is crucial to prevent irreversible joint damage. Based on the patient’s current condition, the following plan can be considered:

1. Pharmacological Treatment
   • First-line therapy includes disease-modifying antirheumatic drugs (DMARDs), such as Methotrexate, combined with corticosteroids (e.g., Prednisone) to suppress disease progression.
   • If the patient does not tolerate or respond to conventional DMARDs, biological agents (e.g., anti-TNF medications) can be considered.
   • In some cases, JAK inhibitors (e.g., Tofacitinib) may be used, particularly in patients with other autoimmune conditions or those unresponsive to traditional therapies.
2. Monitoring and Follow-Up
   • Regular imaging assessments to monitor the progression of joint damage.
   • Periodic screening for common malignancies, given the reported association between MRH and certain tumors.
3. Rehabilitation Exercises and Exercise Prescription
   A gradual and individualized exercise program should be implemented to maintain joint mobility and reduce pain:
   • Initial Phase (Active Inflammatory Stage):
     • Use low-impact, joint-friendly exercises such as active range-of-motion drills (gentle hand, wrist, and ankle movements) 2–3 times per day, 5–10 minutes each session.
     • Apply warm compresses and use joint supports to reduce stress.
   • Improvement Phase (Symptom Relief Stage):
     • Gradually introduce light resistance exercises (e.g., with a resistance band), Frequency 2–3 times/week, Intensity low–moderate, Time 10–15 minutes per session, Type focusing on upper and lower limb joints, and slowly increase sessions or duration.
     • Enhance balance and core muscle training, such as standing balance drills on level ground, to help stabilize the joints.
   • Maintenance Phase:
     • Moderately increase aerobic activities (e.g., walking, swimming, or using a stationary bike) for 20–30 minutes each session, 3–5 times per week.
     • Focus on multi-joint coordination exercises to consolidate joint function, and maintain muscle strength and flexibility.

   During exercise, it is important to protect the joints and avoid strenuous or high-impact activities. Adjust the exercise program if significant pain or swelling occurs.

Disclaimer

This report is a reference analysis intended to provide medical information and clinical reasoning. It does not replace an in-person consultation or professional medical advice. If you have any questions or if your condition changes, please seek prompt medical evaluation and treatment from a healthcare professional.