You have developed pain in both your wrists over the last two weeks. It feels like a deep burning pain and has been pretty much constant. You have been taking ibuprofen which helps but only if you take 400 mg at least three times a day. Your wrists look swollen and are tender when you feel over them. You have found it difficult to move your wrists when you get up and it's taking you much longer to get ready in the mornings.
Yesterday morning you woke to find that the first joint (proximal interphalangeal joint) of your right middle finger was swollen and painful and this morning the same joint in your left ring finger has done the same. You are now struggling to open bottles and jars and finding typing at work very difficult.
Negatives: No fevers, eating and drinking normally, no weight loss. No gastrointestinal symptoms, no headaches, no ear/nose/throat issues, no urinary system issues.
Ideas: You think you may have developed some form of arthritis as a colleague had something similar a few years ago. She was off work for a while and now goes to see a specialist regularly.
Concerns: You are concerned that you are finding it increasingly difficult to use a keyboard and if things get worse will not be able to work.
Expectations: You are expecting that the doctor will refer you to see a specialist and arrange some investigations while you are waiting to be seen.
Feelings: If asked how you feel about your symptoms, say that you are worried because they are starting to affect your work.
Journalist, born in London. Both parents were journalists; mother still writes novels. Eldest of three children; local state school; New College, Oxford (PPE, 2.1). Has worked for various newspapers; now reports on UK and international politics for the Manchester Guardian.
You have returned to get your results. You are keen to hear what has been found. You already suspected a type of arthritis but don’t know much about rheumatoid arthritis and would like to hear more.
You are mostly concerned about what this means for your function and job, and the long-term outlook. You want to know the next steps.
If the student advises referral to a specialist, gladly accept but ask if there is any medication you can take in the meantime for the pain. If they do not offer referral, challenge them and mention that your friend with arthritis sees a specialist regularly.
| Parameter | Normal range | Patient result |
|---|---|---|
| Hb (g/L) | M 130–175 / F 115–150 | 130 |
| MCV (fL) | 80–96 | 84.4 |
| WBC (×10⁹/L) | 3.8–10 | 7.2 |
| Platelets (×10⁹/L) | 150–400 | 230 |
| ESR (mm/hr) | <20 | 54 |
| CRP (mg/L) | <5 | 38 |
| Urate (mmol/L) | M 0.2–0.42 / F 0.14–0.34 | 0.222 |
| U&E / LFTs | — | Normal |
| Rheumatoid factor | — | Positive |
| Anti-CCP | — | Positive |