TY - JOUR T1 - Rheumatology: 1. Is it arthritis? JF - Canadian Medical Association Journal JO - CMAJ SP - 1011 LP - 1016 VL - 162 IS - 7 AU - Stephanie Ensworth Y1 - 2000/04/04 UR - http://www.cmaj.ca/content/162/7/1011.abstract N2 - Case 1: A 29-year-old woman consults her physician 2 months after the birth of her second child because she woke one morning with pain and swelling in her wrists, small joints of the hands, knees, ankles and balls of the feet. She is stiff for an hour after arising and is extremely fatigued but has no other associated symptoms or preceding illnesses. She had reported similar, milder symptoms after her first pregnancy, but the joint pains and stiffness disappeared after 1 month of ibuprofen (400 mg, 4 times daily) treatment. Blood tests reveal a high level of rheumatoid factor and antinuclear antibodies. Case 2: A 69-year-old woman reports that in the year since her last checkup she has had progressive pain in the joints of her fingers, at the base of her thumbs and in her knees, and she has bunions. The pain is worse with activity. She has had minimal (20 min) morning stiffness and no joint swelling, although the small joints of her fingers and the bunions have been developing increasing deformities with deviations and bony enlargements. She recalls that her mother had gnarled fingers at an older age. Her complete blood count and erythrocyte sedimentation rate (11 mm/h) are normal. Case 3: A 40-year-old father of 3 has recently become unable to work as a construction worker because of chronic low-back pain and stiffness, which began when he was in his early 20s. He consults his physician for the first time because his livelihood is in jeopardy. Recently, his thoracic spine between the shoulder blades has been stiff, his shoulders have been painful and 1 knee has been swollen. Otherwise, he is well and blood tests are normal. Case 4: A 50-year-old school teacher has a 3-year history of progressive vague low-back pain associated with pain in the muscles, bones and joints of the arms, legs, neck and chest, sparing the hands. All of the pains are exacerbated by activity. She has some morning stiffness but denies swollen joints. In addition, she has progressively marked fatigue and episodic diarrhea, alternating with constipation. She now feels unable to work because of pain and fatigue. Blood tests and radiographs of her lumbar spine are normal. ER -