A 35-year-old woman consults a physician because of increasing discomfo in her hands over the past year. Her symptoms have developed insidiously and are often worst for the first hour after rising. She has also been experiencing vague symptoms of fatigue and malaise, paicularly in the early afternoon. Physical examination of her hands is notable for tenderness and synol thickening of most of the small hand joints of both hands, paicularly the proximal interphalangeal and metacarpophalangeal joints. A number of joints elsewhere, including in the feet, elbows, and ankles, are also symmetrically involved. An autoantibody directed against lgG is detected in serum. Which of the following is the most likely diagnosis?
This woman most likely has rheumatoid ahritis (RA). This chronic syndrome is characterized by inflammation of peripheral joints, and may or may not be accompanied by systemic manifestations. The American Rheumatism Association has put out revised criteria for the diagnosis of rheumatoid ahritis that require at least 4 of the following for diagnosis: morning stiffness for one hour or longer, ahritis of three or more joints, ahritis of hand joints, symmetric ahritis, rheumatoid nodules, serum rheumatoid factor (RF; anti-IgG) present, and characteristic radiographic changes. In gout, the hands are usually spared, with common sites of involvement including the foot (typically the great toe), knee, wrist, and elbow. Osteoahritis usually produces only a sho period of morning stiffness and commonly involves the distal as well as proximal interphalangeal joints, veebral column, hip, and knee. Osteomyelitis may involve veebrae, feet (usually in diabetics), or the metaphyses of the tibia or femur (more common in children). Osteoporosis causes bone loss, and is usually painless unless a fracture occurs.
Osteoahritis
Osteomyelitis
Osteoporosis
Rheumatoid ahritis