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Answer 5
  1. Ferritin level. Laboratory tests in patients with osteoarthritis are generally normal, including the ESR. No indication to obtain tests for inflammatory processes such as rheumatoid arthritis or systemic lupus erythematosus exists when degenerative changes alone are noted on radiography. The indications for laboratory tests in osteoarthritis are to exclude secondary causes of osteoarthritis, including metabolic diseases and the endocrinopathies. In this case, the factors that suggest a possible secondary cause of osteoarthritis are a relatively young age of the patient, who does not have an occupational risk for premature osteoarthritis, and the unusual distribution involving the metacarpals. Abnormalities of the second and third metacarpal joints are classic for hemochromatosis. Hemochromatosis causes joint symptoms in men at an earlier age than in women, who are protected from excessive iron deposition because of menses. The mechanism of damage of hemochromatosis is believed to be direct damage to chondrocytes from ionic iron.

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