A 45-Year-Old Woman Comes to the Physician Complaining of Pain

question 170

Multiple Choice

A 45-year-old woman comes to the physician complaining of pain in her hands and wrists for the last 3 months.  She says that her hands are "frozen" and tender every morning.  She has no weight loss, fevers, chest pain, or back pain.
Examination of her joints shows mild swelling and tenderness of several proximal interphalangeal joints, metacarpophalangeal joints, and both wrists.  There are no skin rashes or mucosal lesions.  No lymph nodes are palpable.
Laboratory results are as follows:

Which of the following is the most likely diagnosis?

• A)Polymyalgia rheumatica
• B)Reactive arthritis
• C)Rheumatoid arthritis
• D)Systemic lupus erythematosus
• E)Viral infection

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