19th January 2024

A 26-year-old male presents with pain, swelling and tenderness of multiple joints in his right hand

A 26-year-old male presents with pain, swelling and tenderness of multiple joints in his right hand. He states his symptoms started a few months ago and are worse first thing in the morning. He has a past medical history of psoriasis, which occasionally flares up during periods of stress. On examination, he has swelling and tenderness in the distal interphalangeal joints of the second and third fingers. Blood test results showed the following.

Hb 153 g/L (130-180)

MCV 82.5fL (80-96)

WCC 5.0 x 10⁹/L (4.0-11.0)

CRP 12 mg/L (<10)

Sodium 137 (133–146 mmol/L)

Potassium 3.6 (3.5–5.3 mmol/L)

Creatinine 50 (45–84 μmol/ L)

EGFR >90 

Rheumatoid factor 3 (0-20 u/mL)

An x-ray of the hands revealed no obvious abnormalities. 

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