Medical History Female patient, 41 yo, returns to ambulatory care due to pain in toes, fingers, wrists and knees. Since 2002, she has been reported with edema and stiffness of insidious and additive character in wrists, proximal interphalangeal joints, metacarpophalangeal joints and elbows, mainly during the morning, with progressive worsening, without response to non-narcotic analgesics. Physical examination: bilateral edema of interphalangeal and metacarpophalangeal joitns and decreased range of their motion, as well as deformity (proximal interphalangeal hyperextension and distal flexion) of the 5th finger of the right hand. No further abnormalities. Photograph of the dorsal face of the hands and wrists. Simple radiography of the right hand and wrist, in the posteroanterior incidence. Question:Based on the clinical history and images provided, what is the most likely diagnosis? Degenerative osteoarthritis (arthrosis). Systemic lupus erythematosus. Rheumatoid arthritis. Polymyalgia rheumatica. Test Question (SUS-SP -2014 - Direct Access)When requesting serology for the diagnosis of rheumatoid arthritis (rheumatoid factor: RF and Cyclic Citrullinated Peptide: anti-CCP) the physician should bear in mind that: There are patients with the disease who are seronegative for both tests. Although RF has low sensitivity, it has has specificity above 90%. FR may be negative, but not anti-CCP. There may be patients who are negative for anti-CCP but not for FR. Anti-CCP is the most sensitive test for diagnosis, but has low specificity. Time is Up! Time's up
