Rheumatoid Arthritis — Clinical

In rheumatoid arthritis, which of the following joint deformities is caused by ulnar deviation of the fingers with volar subluxation of the metacarpophalangeal joints?

A 42-year-old woman from Delhi presents with a 6-month history of symmetrical swelling and stiffness of the hands, wrists, and knees. Morning stiffness lasts 2 hours. On examination, she has soft tissue swelling over the PIP and MCP joints bilaterally, with reduced grip strength. Laboratory investigations show: ESR 68 mm/hr, CRP 12 mg/dL, RF 1:320 (positive), anti-CCP antibodies 85 U/mL (positive). X-ray of hands shows marginal erosions at the MCP joints. Which of the following is the most appropriate next step in management?

A 38-year-old woman with a 3-year history of rheumatoid arthritis (on methotrexate 20 mg weekly) presents with progressive dyspnea on exertion and dry cough for 2 months. She denies fever, chest pain, or orthopnea. Chest X-ray shows bilateral lower lobe interstitial infiltrates. High-resolution CT chest confirms usual interstitial pneumonia (UIP) pattern. PFTs show FVC 65% predicted, DLCO 48% predicted. Which of the following is the most appropriate management?

A 42-year-old woman presents with a 3-month history of symmetrical polyarthritis affecting the small joints of both hands and wrists, morning stiffness lasting 2 hours, and constitutional symptoms. Physical examination reveals swollen, tender metacarpophalangeal and proximal interphalangeal joints. ESR is 68 mm/h and CRP is 12 mg/dL. Which investigation is most specific for confirming the diagnosis of rheumatoid arthritis?

A 42-year-old woman from Delhi presents with a 6-month history of symmetrical pain and swelling of the small joints of both hands, wrists, and knees. Morning stiffness lasts 2 hours. On examination, she has soft tissue swelling over the PIP and MCP joints bilaterally, with mild ulnar deviation of the fingers. Laboratory investigations show: ESR 68 mm/hr, CRP 12 mg/dL, RF 120 IU/mL (normal <20), anti-CCP antibody 85 U/mL (normal <20). X-ray of hands shows periarticular osteopenia and early marginal erosions. She has no extra-articular manifestations. What is the most appropriate next step in management?