Case 140

Medical history

Female patient-65 year, with previous history of insidious idiopathic pneumopatia and chronic use of systemic corticosteroid on the past 10 years. She was admitted to hospital with dyspnea and dry cough in crises, after prednisone tapering attempt, associated with the mouth and dry eyes, alopecia and severe pain of mechanical rhythm in right hip joint, begun six months ago. At physical exam, the patient displays asymmetric polyarthritis in small joints of hands and mentions arthralgia with inflammatory rhythm and morning stiffness with duration less than 30 minutes. Laboratory tests: Normocytic and Normochromic Anemia, Antinuclear Factor (ANA) + 1/320; Anti-Ro (SS-A) +; Rheumatoid factor (RF) +, Urinalysis (UA) unremarkable, normal levels of C3 and C4.

Based on clinical history and images presented what are the most likely diagnostic hypotheses?

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