Very Rash

A 30 year old woman presents with episodic joint pain and stiffness of both hands for 1 year, which affects her activities of daily living.

There is no morning stiffness and she is well in-between episodes. She also complains of developing oral ulcers recently.

Her medical, drug and obstetric histories are unremarkable. Plain radiographs of both hands and feet are found to be normal.

Select Relevant Investigations
Autoantibody Screen

Performed

ANA titer: 1:80 (normal <1:40)
Anti-dsDNA antibodies: positive
Anti-Ro Antibodies: Negative
Anti-La Antibodies: Negative
Rheumatoid Factor: Negative
Anti-CPA: Negative
Full Blood Count

Performed

WBC/DC: 3,500/mm3
N: 57%, L: 29%
Hb: 10.1 g/dL
PCV (Hematocrit): 43%
Platelets: 79,000/mm3
Urinalysis and Renal Functions

Performed

Appearance: clear
Pus Cells, RBC, Cell Casts: nil/hpf
Urea: 4.5 mmol/L (2.5-6.7)
Creatinine: 0.9 mg/dl (0.8-1.4)
ESR + CRP

Performed

ESR: 80 mm/1h (< 15)
CRP: 0.8 ng/ml (< 6)

Select Relevant Management
Rituximab
Sun Screen
Hydroxychloroquine
Methotrexate