A 45-year-old female comes to the physician with joint pain, swelling and morning stiffness which improves with use. She also reports weight loss of 3 kg (6.6 lbs). Laboratory tests reveal the…

Question

Options

• Aanti-acetylcholine receptor antibodies
• Banti-centromere antibodies
• Canti-cyclic citrullinated peptide antibodies
• Danti-smooth muscle antibodies
• Eanti-U1 ribonucleoprotein antibodies

• A
  3% (1)
• C
  82% (31)
• D
  11% (4)
• E
  5% (2)

Explanation

This patient most likely has rheumatoid arthritis (RA) which is an autoimmune disease characterized by inflammation and erosion of articular cartilage and bone. It presents with weight loss, fatigue, joint pain, swelling and morning stiffness which lasts longer than an hour and improves with use. It usually involves the metacarpophalangeal joints, proximal interphalangeal joints and the wrist joints. Laboratory findings in patients with RA include IgM antibodies against the Fc region of IgG (rheumatoid factor), HLA-DR4 and anti-cyclic citrullinated peptide antibodies which are more specific for RA. Synovial fluid analysis also reveals joint inflammation unlike in osteoarthritis which is non-inflammatory. Management of RA includes treatment with NSAIDs, glucocorticoids, methotrexate, leflunomide, hydroxychloroquine and biologic agents like TNF- alpha inhibitors such as etanercept.

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