Testing, testing, testing

Stage A 55-year-old woman presented with polyarticular arthritis. She had had several attacks of symmetric arthritis during the previous few months, involving particularly the ankles, shoulders, and metacarpophalangeal and proximal interphalangeal joints. She also reported morning stiffness and fatigue, but no other systemic symptoms. No infection or febrile illness preceded the onset of her symptoms. Her medical history was otherwise unremarkable. Response The patient's age, the onset of symptoms, and the clinical picture support a presumptive diagnosis of rheumatoid arthritis. The absence of fever and the chronic, relapsing course are inconsistent with most infectious arthritides. A reactive arthritis is also.