A 33-year-old nurse presents to your office with a complaint of intermittent episodes of pain, stiffness, and swelling in both hands and wrists for approximately 1 year. These episodes last for several weeks and then resolve. Recently, she noticed similar symptoms in her knees and ankles. Joint pain and stiffness are interfering with her ability to perform her duties at work. The joint stiffness usually lasts for several hours before improving. She also reports malaise and easy fatigability for the past few months.
Examination : BP : 120/70 mm Hg, HR : 82 bpm RR : 14 breaths per minute. Her skin does not reveal any rashes. Head, neck, cardiovascular, chest, and abdominal examinations are normal. There is no hepatosplenomegaly. The examination of joint reveals the presence of bilateral swelling, redness and tenderness of most proximal interphalangeal (PIP) joints, metacarpophalangeal…
