KNUCKLE PAIN
A 40 yr old female comes in to the office with complaints of joint pain in in both of her knuckles (metacarpophalangeal joint). Her knuckles have been very swollen and painful. She says that it is worse in morning and lasts for several hours after waking. She says that this has been ongoing for months and progressively getting worse.
An anti-CCP test is ordered and comes back positive. (She has other tests as well, that were also positive, but will focus just on this lab). She says her grandma has some kind of issue similar to her but can’t remember what the diagnosis is called.
What is the most likely dx?
ANSWER
RHEUMATOID ARTHRITIS
LABS: Positive Anti-CCP (70%+) & RF (60-70%+) (Epocrates)
S/S: bilateral MCP Joint pain, swan neck deformity (advanced), rheumatoid nodules, scleritis, joint swelling
Female, 40’s+, genetic predisposition- family history
Imaging: X-ray may show some erosion of joints
Morning stiffness >1 hr
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