-2 :: Case - 2653 ::
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A 43-year-old Jamaican female presents for evaluation of a chronic arthritis which began in 1986.

At the time of onset she had a genitourinary infection which was treated with penicillin. One week later her arthritic symptoms began, manifesting oroginally as a monoarthritis involving one finger of the left hand.

Over the next several weeks, recurrent swelling and pain occurred which were refractory to NSAIDs. She developed an additive progressive polyarthritis eventually involving both wrists, both hands, the left knee, and both ankles.

Besides steroids, she has tried multiple disease-modifying anti-rheumatic medications such as d-penicillamine, plaquenil, azithromycin, methotrexate and NSAIDs.

There was limited range of motion in the left shoulder and some muscle atrophy. She had 1-2+ active synovitis in multiple joints in both wrists and hands and in both knees.

ESR was 85 and rheumatoid factor was negative.