24th February 2025

A 57-year-old woman with a background of poorly controlled type 2 diabetes mellitus, hypothyroidism and obesity attends clinic to follow up on a previous consultation.

A 57-year-old woman with a background of poorly controlled type 2 diabetes mellitus, hypothyroidism and obesity attends clinic to follow up on a previous consultation. She has been troubled by bilateral hand pain for around six months, which gets better with rest but gets worse when using her hands at work as a chef. When last examined, your colleague noted that most of the small joints of the hand were described as sore, particularly both carpometacarpal (CMC) joints. Reassuringly, there was no erythema or swelling. Observations are unremarkable. Blood tests show a normal FBC, CRP and ESR, a positive ANA but negative RF and anti-CCP and a borderline urate. An X-ray of both hands is reported as showing early degenerative changes at the CMC joints with no other findings. Given the overall picture, what do you think the likely diagnosis is?

Select the SINGLE most appropriate option from the list below. Select ONE option only.