Questions for Discussion with answers:

  1. What features will help you to distinguish inflammatory from non-inflammatory disease?  Answer

She has noted swelling in the wrists, MCP'S, PIP'S and knees. There is also pain across the metatarsal region and she has had difficulty finding comfortable shoes. She has no prior joint complaints.

Past Hx: Unremarkable
ROS:      Marked fatigue

  1. What other questions should you ask? What are your diagnostic thoughts now?  Answer

PE: Synovitis of both wrists, 2 nd , 3 rd & 5 th MCP bilaterally
       PIP bilaterally
       both knees
       MTP are very tender

General exam is unremarkable

  1. What tests should be considered? Answer
  2. How do you make a diagnosis rheumatoid arthritis?  Answer