A 40 year old Indian female, came with complaint of morning stiffness in her joints since 4 months. She noticed the swelling and pain increase gradually in the joints of both her hands (Wrists, MCP and Proximal Interphalangeal joints were found to be involved on examination). She told that she has severe pain in the morning and as she starts to do her morning chores, the pain tends to get slightly better. Patient has no history of any nodules/ dry eyes/ dry mouth/ dry cough with dyspnea/ petechiae. On enquiry, she mentioned that her mother had Rheumatoid Arthritis. Patient gives no history of smoking. There is also no history of any drug allergies.
On examination, patient has the following vitals:
Blood pressure- 118/76 mm of Hg
Pulse- 76beats per minute
Respiratory rate- 18 cycles per minute.
There is no sign of pallor/swollen lymph nodes/edema.
No abnormalities were found in cardiovascular and respiratory systems. No functional neurological deficits were present.
The swelling and tenderness of the above joints are confirmed on local examination. The movement of the above joints were restricted bilaterally with slight flexion at the 2nd Proximal Interphalangeal Joint of her Right hand.
No abnormality or restricted movements found in other joints.
1. What is the condition depicted in the Image A?
2. Not seen in this patient, but the deformity seen in Image B is classically seen in Rheumatoid Arthritis
3. A test with diagnostic and prognostic significance, that you would like to order in this case?
4. Which is the drug of choice in this case?