A middle-aged woman with gradual symptom onset, daily fatigue, low-grade fever, morning stiffness about 60 minutes, and tender and swollen fingers in DIP/PIP joints most likely has which condition?

A middle-aged woman with gradual symptom onset, daily fatigue, low-grade fever, morning stiffness about 60 minutes, and tender and swollen fingers in DIP/PIP joints most likely has which condition?

• A. Gout
• B. Rheumatoid arthritis
• C. Osteoarthritis
• D. Systemic lupus erythematosus

Answer: (B)

Inflammatory arthritis with systemic symptoms best fits this presentation. Middle-aged individuals who develop fatigue and a low-grade fever, along with joint swelling and prolonged morning stiffness—about an hour or more after waking—point toward rheumatoid arthritis. RA typically affects the small joints of the hands, especially the PIP and MCP joints, in a symmetric pattern, and the stiffness is persistent rather than brief. This contrasts with osteoarthritis, where stiffness tends to be shorter in duration and the DIP joints are more commonly involved, often with bony enlargements and less systemic illness. Gout presents as an acutely painful, red, swollen joint rather than a gradual, ongoing process with morning stiffness. Systemic lupus arthritis can occur but is usually nonerosive and accompanied by other systemic signs; the combination of chronic, inflammatory polyarthritis with fatigue and fever most strongly supports rheumatoid arthritis.

Inflammatory arthritis with systemic symptoms best fits this presentation. Middle-aged individuals who develop fatigue and a low-grade fever, along with joint swelling and prolonged morning stiffness—about an hour or more after waking—point toward rheumatoid arthritis. RA typically affects the small joints of the hands, especially the PIP and MCP joints, in a symmetric pattern, and the stiffness is persistent rather than brief. This contrasts with osteoarthritis, where stiffness tends to be shorter in duration and the DIP joints are more commonly involved, often with bony enlargements and less systemic illness. Gout presents as an acutely painful, red, swollen joint rather than a gradual, ongoing process with morning stiffness. Systemic lupus arthritis can occur but is usually nonerosive and accompanied by other systemic signs; the combination of chronic, inflammatory polyarthritis with fatigue and fever most strongly supports rheumatoid arthritis.