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A 55-Year-Old Man Comes to the Office Due to a 2-Year

question 353

Multiple Choice

A 55-year-old man comes to the office due to a 2-year history of pain in both hands with intermittent swelling of the finger joints. The pain impairs his functioning as a carpenter. He also has stiffness in the knees after prolonged sitting. Review of systems is negative for any other systemic or physical symptoms.
His other medical problems include chronic bronchitis, impaired glucose tolerance, and a history of nephrolithiasis. His home medications include ibuprofen as needed, glucosamine/chondroitin supplements, and aspirin. His father died of cardiomyopathy at age 75. The patient does not use illicit drugs but smokes a pack of cigarettes daily and drinks 2 mixed alcoholic beverages every night.
His vital signs are within normal limits. Finger nails appears pitted. There is boggy swelling and tenderness to palpation involving all the proximal and distal interphalangeal joints.
Laboratory results are as follows:

Chest x-ray reveals hyperinflation of the lungs but is otherwise normal. Hand x-ray is shown in the exhibit.
Which of the following is the most likely diagnosis?

Definitions:

Transparency

The practice of being open, honest, and straightforward about various aspects of a company's operations, policies, and decisions.

Social Commerce

The use of social media platforms to promote and sell products and services directly within the social media experience.

Reciprocity

A principle or practice of mutual exchange, where actions or benefits are returned in kind, often as part of social or economic interactions.