A 50-year-old woman presented with complaints of intermittent pain in her hand joints. She had a history of morning sickness for the past nine months. She also suffered from episodes of fever, fatigue, alopecia, malar rash, and oral ulcers for nine years.
Physical examinations Oral cold sores Tenderness of 2 nd and 3 rd interphalangeal joints bilaterally along with swelling Tenderness of wrist joints Bilateral ulnar deviation Swan neck deformities were observed on the second finger of her right hand X-ray images have been provided. Laboratory examination ESR: 45 mm/h CRP: 3.39 mg/dL Rheumatoid factor: 393 IU/mL Antinuclear antibodies (ANA): 1/100 positive Anti-CCP level: 500 U/mL anti-dsDNA: Positive C4: 13.2 mg/dl Urine protein-to-creatinine ratio (UP/CR): 50mg/gm of creatinine Liver and renal functions: Normal What can be the probable diagnosis? (Answer is posted in the comment…
