A 55-Year-Old Man Comes to the Physician Complaining of Joint

question 519

Multiple Choice

A 55-year-old man comes to the physician complaining of joint pain.  He has had 2 years of intermittent and mild arthralgias of his hands, wrists, and shoulders at night.  He recently developed pain in his wrists and hand pain with flexion mainly at the second and third metacarpophalangeal joints.  He has no morning stiffness or warmth or redness around his joints.  There is no history of fever, weight loss, or subcutaneous nodules.  His medical problems include type 2 diabetes mellitus diagnosed 5 years ago and hypertension and hyperlipidemia diagnosed 3 years ago.  Mild liver function abnormalities were detected and attributed to possible fatty liver 2 years ago.  His medications include metformin, lisinopril, and rosuvastatin.
The patient's vital signs are within normal limits.  BMI is 34 kg/m².  There is swelling of the metacarpophalangeal joints bilaterally.  He has no synovial swelling or abnormalities of his proximal and distal interphalangeal joints.  There are no abnormalities of the wrists, shoulders, or hips.
X-rays of the hands and wrists reveal narrowing of the third, fourth, and fifth metacarpophalangeal joints with hook-shaped osteophytes at the metacarpal heads.  Erythrocyte sedimentation rate is 15 mm/hr.
Which of the following would most likely show the cause of this patient's current symptoms?

• A)Discontinuation of rosuvastatin
• B)HLA-B27 testing
• C)Rheumatoid factor and anti-citrullinated peptide antibodies
• D)Serum transferrin saturation
• E)Uric acid levels

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