Ms. Santos, a 45-year-old female, presents with joint pain, swelling and stiffness in her hands and wrists. She also complains of fatigue and morning stiffness lasting for more than an hour. Upon physical examination, the nurse notes symmetrical joint swelling and tenderness in the metacarpophalangeal and proximal interphalangeal joints. The patient’s rheumatoid factor and anti-cyclic citrullinated peptide ( Anti-ccp ) antibodies are positive.
