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 Best of Five 2.12

 

   

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BOF: 2.12

A 45-year-old female presents with a 2-month history of slowly progressive pain, stiffness lasting more than half and hour in the morning and swelling of the joints of her fingers and wrists. She feels generally unwell with early afternoon fatigue and malaise. On examination she appears to have lost weight, there is swelling of her metacarpophalangeal joints and the proximal interphalangeal joints. Investigations reveal

Hb 10.0 g/dL

MCV 95 fL

ESR 70 mm in the 1st hour

Rheumatoid Factor: 50 k IU/L

The features that would suggest that this patient has a worse than average prognosis are:

a)      Female patient, gradual onset over a few months, positive IgM rheumatoid factor, anaemia

b)      Early afternoon fatigue and malaise, loss of weight, high ESR, normocytic anaemia

c)      Involvement of metacarpophalangeal joints, morning stiffness, positive rheumatoid factor, high ESR, anaemia

d)      Loss of weight, involvement of metacarpophalangeal joints, positive IgM rheumatoid factor, anaemia, high ESR

e)      Fatigue and malaise, positive IgM rheumatoid factor, anaemia, high ESR

 

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