Ulnar drift is most commonly associated with which condition?

• A. Rheumatoid Arthritis
• B. Osteoarthritis
• C. Gout
• D. Scleroderma

Answer: (A)

Ulnar drift of the fingers signals a hand deformity from inflammatory joint disease, most classically rheumatoid arthritis. In RA, chronic synovitis attacks the tissues around the metacarpophalangeal joints, weakening ligaments and the extensor mechanism. This loss of support lets the fingers drift toward the ulnar side and can progress to subluxation of the MCP joints. The pattern is characteristic of inflammatory destruction rather than simple wear or deposition.

Osteoarthritis tends to produce bony enlargements and Heberden or Bouchard nodes with a more stable, less drifted alignment. Gout can cause swelling and tophi but does not typically create a persistent ulnar drift. Scleroderma may cause hand tightening and digital ulcers, but ulnar drift is not a defining feature. So the association with rheumatoid arthritis best explains ulnar drift.