An important message regarding the current COVID-19 pandemic. Click here to read more.


Very Rash

Step 1: View clinicals

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.

Step 2: Order all relevant investigations

Autoantibody Screen

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

Full Blood Count

WBC/DC: 3,500/mm3 N: 57%, L: 29% Hb: 10.1 g/dL PCV (Hematocrit): 43% Platelets: 79,000/mm3

Urinalysis and Renal Functions

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)

Step 3: Select appropriate management

Sun Screen

Score: ★★☆