Excerpt
A 53-year-old woman with a 10-year history of symmetric polyarthritis involving primarily the small joints of the hands bilaterally presented in our outpatient rheumatology clinic for evaluation. She reported not receiving any disease modifying antirheumatic drugs except paracetamol and occasionally nonsteroidal antiinflammatory drugs. She denied Raynaud’s phenomenon, psoriatic rashes, mouth ulcers, or uveitis. Laboratory evaluation showed hemoglobin 9 g/dl, with features of anemia of chronic disease (low serum iron and normal ferritin levels). C-reactive protein (CRP) was 51 mg/l (normal < 6 mg/l) and erythrocyte sedimentation rate (ESR) 69 mm/h. Serum IgM rheumatoid factor (RF) was positive at titer 1/1280…