26th January 2024

A 69-year-old female presents with a few months of pain in her hands.

A 69-year-old female presents with a few months of pain in her hands. As a result, she has noticed difficulties completing simple tasks such as doing up the buttons on her shirt and opening jars. On examination, she has swellings on her left second and third distal interphalangeal joints, and right second distal interphalangeal joint. Nails are normal. There is tenderness to palpation over the swollen areas. Her maternal grandmother had a history of psoriasis. Her blood test results are as follows: 

Hb 145 g/L (130-180)

MCV 92.5fL (80-96)

WCC 5.0 x 10⁹/L (4.0-11.0)

CRP 3 mg/L (<10)

U&Es normal  

LFTs normal 

ESR 1

Rheumatoid factor 3 (0-20 u/mL)

Anti-CCP negative 

Serum uric acid 394 (200–430 μmol/L)

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