A 38-Year-Old Woman Is Evaluated for Joint Pain and Fatigue

question 36

Multiple Choice

A 38-year-old woman is evaluated for joint pain and fatigue, which has been slowly progressive over the last year.  Her other past medical problems include migraine headaches, lower back pain, and non-ulcer dyspepsia.  She has had no miscarriages or thrombotic events.
Vital signs are within normal limits.  Her body mass index is 30 kg/m².  Examination shows symmetric tenderness of multiple small joints in the hands and a small effusion at the left knee.
X-ray image of the left hand is shown below.

Which of the following would have the most prognostic value for this patient?

• A)Anti-cyclic citrullinated peptide antibodies
• B)Antinuclear antibody profile
• C)Anti-tissue transglutaminase antibodies
• D)Number of fibromyalgia tender points
• E)Fasting transferrin saturation

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Definitions:

Disease Spread

The transmission of illnesses through populations via various vectors, including person-to-person contact, animals, or the environment.

Adams-Onís Treaty

An 1819 agreement between the United States and Spain that ceded Florida to the U.S. and defined the boundary between the U.S. and New Spain.

Louisiana Purchase

The Louisiana Purchase was a land deal between the United States and France in 1803, wherein the U.S. acquired approximately 827,000 square miles of land west of the Mississippi River.

49th Parallel

denotes the approximate boundary line between the United States and Canada, established in parts by the Oregon Treaty of 1846.