A Question A Day (W2D3)

Most likely rheumatoid arthritis, as suggested by the morning stiffness, symmetrical swelling of PIP
and MCP joints, & tender joints. Other not so significant risk factors include raised ESR, age, gender.
(Note: should have done the RA squeeze test)

Not likely SLE as negative ANA helps exclude SLE (sensitivity 100%) although supported by morning
stiffness and the arthritis distribution. There is no skin lesion as well

Not likely primary osteoarthritis although the findings and history might match, but it should have a
predilection for older age. Occurrence of OA in young age like 35 above is only less than 10%

Not likely psoriatic arthritis as no prior history of rash (although 30% of pt with psoriatic arthritis
have no psoriatic rash).

Mouth ulcers are present in Behcet’s, RA, SLE. However insignificant in this case to be diagnostic

Dr Rachel Joshua in one of a CME talk confirmed that the presence of the 3 S is good enough to
diagnose RA: Stiffness, Swelling, Squeeze test for RA at MCP and MTP joint. Would have been great
to have done the squeeze test (sensitivity 40-48% and specificity of 84%)