A 48-year-old man complains of joint pain and stiffness for the past three months. All of the following are evidence of the diagnosis of rheumatoid ahritis (RA), EXCEPT:
Morning stiffness lasting more than one hour is characteristic of RA. Bilateral and symmetrical metacarpophalangeal joint involvement is very common. Subcutaneous rheumatoid nodules are found in 20-25% of patients, especially over the olecranon, extensor forearm, and Achilles' tendon. Some patients experience Raynaud's phenomenon, that is, blanching of the fingers on exposure to cold. Polymorphonuclear leukocytes predominate in synol fluid from patients with RA. Ref: O'Dell J.R., Imboden J.B., Miller L.D. (2013). Chapter 15. Rheumatoid Ahritis. In J.B. Imboden, D.B. Hellmann, J.H. Stone (Eds), CURRENT Diagnosis & Treatment: Rheumatology, 3e.
Early morning stiffness lasting one hour
Numbness and blanching of fingers on exposure to cold
Symmetrica linvolvement of the metacarpophalangeal joints
Synol fluid with high viscosity and 30,000 lymphocytes/mm3