26th February 2025

You see a 65-year-old female in rheumatology clinic.

You see a 65-year-old female in rheumatology clinic. She has been referred from her general practitioner with Raynaud’s phenomenon and joint pains. She tells you she has felt extremely ‘run down’ and weak recently and has noted joint swelling and pain in her knuckles. On direct questioning, she admits she has felt slightly shorter of breath than usual; however, she had put this down to doing less exercise during lockdown.

On examination, you note rough, thickened and cracked skin at the tips of her fingers and multiple tender and swollen joints to the PIP and MCPJs bilaterally. Power is difficult to assess in the upper limbs due to joint pains, and her power in hip flexors is 4+/5 bilaterally; otherwise, it is 5/5. Heart sounds are normal, and on auscultation of the chest, you note quiet bibasal fine inspiratory crackles.

 What is the most likely diagnosis?

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