Pediatrics Q# 147................................. - triplehelix

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A 17-year-old girl comes to the clinic with
several weeks of joint pain and rash. The
joint pain is most prominent in the hands.
She states that the pain is most severe in the
morning and tends to improve over the day.
She has noted some swelling of her fingers.
She has also had a rash on her face that becomes
more prominent when she is outside.
She states that the sunlight tends to bother
her eyes. On further questioning, she states
that she has not felt well for several months.
She has had intermittent fever, has been
more tired than usual, and has lost weight
even though she has not been dieting. On
physical exam, she looks tired. She has lost 5
pounds since her last visit one year ago. She
has an erythematous rash on her cheeks. She
has several shallow ulcers in her mouth. She
has fusiform swelling of her fingers and pain
with movement of her fingers. Which of the
following in the most likely diagnosis?
(A) systemic lupus erythematosus (SLE)
(B) dermatomyositis
© juvenile rheumatoid arthritis
(D) rheumatic fever
(E) Lyme disease