Asymmetric

Multisystem Processes & Disorders


Step 1: View Clinicals

A 35 year old man presents with mild pain in the joints of his fingers and toes for one year. The joints are stiff upon waking up, but the stiffness gradually wears off over a few hours. Hand functions are unaffected.


He also experienced an episode of pain in the left knee joint around 3 years ago, which subsided spontaneously, with no aftereffects.


His medical and surgical history is unremarkable, and he is not on any drugs.


Step 2: Order Relevant Investigations

1. Rheumatoid Factor

check

The Rheumatoid Factor assay is negative.

2. X-Ray B/L Hands

check

There are mild erosive changes in the center of the affected distal interphalangeal joints in both hands, with minimal juxta articular osteopenia.

3. ESR and CRP

check

ESR: 38 mm/1h (<20)

CRP: 4 mg/dL (0-1.0 mg/dL)

4. ANA

clear

ANA levels are within normal parameters for his age and gender.

Step 3: Select Appropriate Management

1. NSAIDs

check

2. Physiotherapy

check

3. Sulfasalazine

check

4. Anti-TNF

clear