A 39-year-old woman comes to the physician because of progressive pain and swelling of her wrists and hands for the past 2 months. Her hands are stiff in the morning; the stiffness decreases as she starts her chores. She also reports early-morning neck pain at rest for the past 3 weeks. She has no history of serious illness and takes no medications. Her sister has systemic lupus erythematosus. Vital signs are within normal limits. Examination shows bilateral swelling and tenderness of the wrists, second, third, and fourth metacarpophalangeal joints; range of motion is limited by pain. There is no vertebral tenderness. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Laboratory studies show anemia. Which of the following is most likely to be the earliest finding during the development of this patient's condition?

Question

A 39-year-old woman comes to the physician because of progressive pain and swelling of her wrists and hands for the past 2 months. Her hands are stiff in the morning; the stiffness decreases as she starts her chores. She also reports early-morning neck pain at rest for the past 3 weeks. She has no history of serious illness and takes no medications. Her sister has systemic lupus erythematosus. Vital signs are within normal limits. Examination shows bilateral swelling and tenderness of the wrists, second, third, and fourth metacarpophalangeal joints; range of motion is limited by pain. There is no vertebral tenderness. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings.   Laboratory studies show anemia.  Which of the following is most likely to be the earliest finding during the development of this patient's condition?

Quizplus · Accepted Answer

Eductional Objective: Rheumatoid arthritis is characterized by synovial hyperplasia with inflammatory infiltrates.  The accelerated metabolic rate of the inflamed synovium causes local hypoxia, which leads to synovial angiogenesis.  As the disease progresses, the joint space is replaced by a rheumatoid pannus (an invasive mass of fibroblast-like synovial cells, granulation tissue, and inflammatory cells) which can destroy the articular cartilage and underlying subchondral bone.

A 39-Year-Old Woman Comes to the Physician Because of Progressive