Case history
Case history
A 52-year-old woman presents with a 2-month history of bilateral hand and wrist pain, and swelling in her fingers. She has also recently noted similar pain in the balls of her feet. She finds it hard to get going in the morning and feels stiff for hours after waking up. She also complains of increasing fatigue and is unable to turn taps on and off or use a keyboard at work without a significant amount of pain in her hands. She denies any infections before or since her symptoms started.
Other presentations
Rheumatoid arthritis (RA) can sometimes present in large joints like the knees and shoulders but this is less common. There is some evidence that elderly-onset RA may present this way more often.[6] Elderly-onset RA has also been grouped with polymyalgia rheumatica (PMR) and may represent a continuum of clinical features of both RA and PMR.[7] Rheumatoid nodules can be seen at presentation in some patients who have very active disease with large numbers of joints involved; these patients also have a higher incidence of other extra-articular manifestations.[8]
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