Summary: This is a 32-year-old woman with a I-year history of symmetric polyarticular arthritis and morning stiffness. Joint examination reveals the presence of bilateral swelling, redness and tenderness of her PIP joints, MCP joints, wrists, and knees. She has a mild normocytic anemia with an otherwise normal complete blood count (CBC). Urinalysis, renal, and liver function tests are normal. The ESR is elevated, suggesting an inflammatory cause of her arthritis.
^ Most likely diagnosis: Rheumatoid arthritis (RA). ♦ Next diagnostic step: Rheumatoid factor and antinuclear antibody titer.
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