Rheumatoid arthritis Quiz: Ace Your Exams
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A 64-year-old woman presents to the clinic for evaluation of a 5-year history of bilateral hand pain and stiffness. She has not previously received medical attention for the joint pain and it has progressed over time to affect her feet as well. The stiffness is worse in the morning and when she is inactive for long periods, lasting over an hour and gradually improving with activity. She has no fevers or unintentional weight loss. Medical history is significant for high cholesterol. Temperature is 37.2°C (98.9°F), pulse is 88/minute, respiratory rate is 16/minute, and blood pressure is 130/82 mmHg. Physical examination shows tenderness and swelling of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints on both hands, as well as metatarsophalangeal joints on both feet. There is no warmth or erythema. She is unable to fully close her fists due to pain and she has reduced grip strength. Which of the following additional physical examination findings would support the most likely diagnosis?
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