08-04-2011, 06:23 AM
A 53-year-old woman is evaluated for a 3-month history of bilateral knee pain on ambulation. Her pain is more notable in her right knee. She has approximately 15 minutes of stiffness each morning. She has swelling of the proximal and distal interphalangeal joints. She does not have fever, rash, photosensitivity, or oral ulcers. Her sister has systemic lupus erythematosus.
Musculoskeletal examination reveals no redness or palpable synovial swelling, but she has bilateral bony hypertrophy at the third and fourth distal and proximal interphalangeal joints. Range of motion elicits bilateral knee crepitus. There is evidence of a small right knee effusion.
Which of the following studies will be most useful in establishing this patient's diagnosis?
A Erythrocyte sedimentation rate
B Antinuclear antibody assay
C Rheumatoid factor assay
D Anti–cyclic citrullinated peptide antibody assay
E No additional studies
Musculoskeletal examination reveals no redness or palpable synovial swelling, but she has bilateral bony hypertrophy at the third and fourth distal and proximal interphalangeal joints. Range of motion elicits bilateral knee crepitus. There is evidence of a small right knee effusion.
Which of the following studies will be most useful in establishing this patient's diagnosis?
A Erythrocyte sedimentation rate
B Antinuclear antibody assay
C Rheumatoid factor assay
D Anti–cyclic citrullinated peptide antibody assay
E No additional studies