A 30 year old woman presents with episodic joint pain and stiffness of both hands for 1 year, which affects her activities of daily living. There is no morning stiffness and she is well in-between episodes. She also complains of developing oral ulcers recently. Her medical, drug and obstetric histories are unremarkable. Plain radiographs of both hands and feet are found to be normal.
ANA titer: 1:80 (normal <1:40) Anti-dsDNA antibodies: positive Anti-Ro Antibodies: Negative Anti-La Antibodies: Negative Rheumatoid Factor: Negative Anti-CPA: Negative
WBC/DC: 3,500/mm3 N: 57%, L: 29% Hb: 10.1 g/dL PCV (Hematocrit): 43% Platelets: 79,000/mm3
Appearance: clear Pus Cells, RBC, Cell Casts: nil/hpf Urea: 4.5 mmol/L (2.5-6.7) Creatinine: 0.9 mg/dl (0.8-1.4)
ESR: 80 mm/1h (< 15) CRP: 0.8 ng/ml (< 6)