A 34-year-old female presents complaining of symmetrical redness and swelling of the small joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following diagnosis is most likely?
- progressive systemic sclerosis
- CREST syndrome
- osteoarthritis
- rheumatoid arthritis
- ankylosing spondylitis
Answer: D
Rheumatoid Arthritis
In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA). 80% of patients with RA will have a positive RF, but 20% will be negative. PSS involves squamous cell thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine)
Know Your Content Blueprint
Rheumatoid Arthritis is part of the NCCPA Content Blueprint Musculoskeletal System (10%)
Review Topic: Rheumatoid Arthritis