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59-year-old woman with persistent thumb stiffness and worsening symptoms after corticosteroid treatment

Hello,

I need some help with diagnosing and managing a case.
Patient Details:

Age: 59
Symptoms: Stiffness in both thumbs for the past 9 days, morning stiffness that does not improve throughout the day, no fever, no chills. Symptoms worsened after a week of corticosteroid treatment.
Medical History: Previous stroke, hypercholesterolemia.
Medications: Statins, aspirin.
Sexual History: Sexually active, had unprotected intercourse 2 weeks ago.
Physical Examination: Generally well, no fever, tenderness upon palpation of the right thumb and ankles, the 1st metacarpophalangeal joint is warm and red, both ankles warm with synovitis but not edematous.
Lab Results: Elevated CRP (48 mg/L), slightly increased white blood cells, presence of 5-10 white blood cells per field in urine.
Questions:

What additional history should I gather?
What differential diagnoses should I consider?
What further tests should I order?
What could be the final diagnosis?
What treatment plan should I propose?
Thank you for your insights!

  1. I am sorry to read that the patient’s symptoms worsened in spite of corticosteroids. It can be so difficult to arrive at the correct diagnosis. We are not physicians so are unable to diagnose or recommend treatments. Maybe this article outlining the process of diagnosing RA is helpful?

    https://rheumatoidarthritis.net/diagnosis

    My suggestion would be for the patient, perhaps with your help, to discuss their questions with the HCP that prescribed the corticosteroids. If the HCP is unable to help, they should be able to make an appropriate referral. That may be a Rheumatologist or other specialist. I Hope for diagnosis and relief for the patient very soon, Jo

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