<prompt> A patient of 45 yrs old Having ahritis with involvolvement of PIP 4 DIP and 9 MCP and sparing of wrist and ankle diagnosis ?osteoahritisRheumatoid AhritisPsoriatic ahritisGouT  <response>: Osteoahritis is a non-inflammatory, degenerative condition of joints Characterized by degeneration of aicular cailage and formation of new bone is. osteophytes. Primary OA More common than secondary OA Cause --Unknown Common-in elders where there is no previous pathology. Its mainly due to wear and tear changes occuring in old ages mainly in weight bearing joints. SECONDAY OA : Due to a predisposing cause such as: linjury to the joint 2.Previous infection 3. RA 4.CD 5. Deformity 6.Obesity 7.hypehyriodism Clinical features Pain and tenderness -- Usually slow onset of discomfo, with gradual and intermittent increase -- Pain is more on wt. bearing due to stress on the synol membrane later on due to bone surface,which r rich in nerve endings coming in contact. -initially relieved by rest but later on disturb sleep. -Diffuse sharp and stabbing local pain Movement abnormalities - ;Gelling;: stiffness after periods of inactivity, passes over within minutes approx 15min. of using joint again -- Coarse crepitus: palpatehear due to flaked cailage eburnated bone ends -- Reduced ROM: capsular thickening and bony changes in joint,ms. Spasm or soft tissue contracture. REF : MAHESWARI 9TH ED 