Approach to Inflammatory Arthritis & Rheumatoid Arthritis
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Clinical VignetteQuestion 1 of 25
Morning Knee Thaw
A 58-year-old woman presents with 10 weeks of bilateral knee pain. Each morning she sits on the edge of her bed for nearly 90 minutes before her knees loosen up enough to walk to the bathroom; once she has been moving for an hour, she says the pain noticeably eases and she can manage the stairs. By evening, after a day of activity, her knees feel somewhat better than they did at waking. She has no history of trauma and takes no regular medications. Temperature is 37.1 C, pulse 78/min, blood pressure 126/78 mmHg. Examination reveals bilateral knee effusions with soft, boggy periarticular swelling and warmth; there is no crepitus and no bony enlargement of the joint margins. Range of motion is mildly reduced. ESR is 62 mm/hr and CRP is 3.8 mg/dL. Radiographs show no joint space narrowing.
Which of the following best explains this patient's joint disease?