18th January 2024

A 43-year-old lady presents with a 4-month history of general malaise and pain in the small joints of her hands and feet.

A 43-year-old lady presents with a 4-month history of general malaise and pain in the small joints of her hands and feet. She also has stiffness lasting around 40 minutes in the morning. On examination, she had swelling of her 3rd and 4th MCP joints and some fluid around the right ankle joint. There was a subcutaneous nodule on the extensor surface of the left elbow. 

Investigations:

Haemoglobin 135 g/L (115-165)

Mean Cell Volume 86.5fL (80-96)

ESR 45mm/1st hour (<20)

CRP 40mg/L (<10)

Rheumatoid Factor negative 

Anti-CCP borderline positive 

Which factor is most likely to confer a better prognosis for this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.