25th February 2025

A patient is seen in rheumatology clinic after moving from abroad, complaining of years of severe pain and stiffness in the fingers, often worse in the morning and improving throughout the day.

A patient is seen in rheumatology clinic after moving from abroad, complaining of years of severe pain and stiffness in the fingers, often worse in the morning and improving throughout the day. This affects fingers on both hands. They also suffer from fatigue. They have been unable to work as a secretary.

Bloods show:

Rheumatoid factor 18 (0-16)

Anti-CCP 6 (0-7)

ANCA negative

Nuclear (ANA) antibody negative

ESR 60 (0-10)

X-rays are taken of the hands, showing the following abnormality:

Which condition is most likely?

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