A 40-year-old woman presents with bilateral pain and swelling in hand joints. What is the most likely diagnosis?

• A. Rheumatoid arthritis
• B. Polymyalgia rheumatica
• C. Osteoarthritis
• D. Ankylosing spondylitis

Answer: (A)

The most likely diagnosis in this scenario is rheumatoid arthritis, particularly given the patient’s age and the presentation of bilateral pain and swelling in the hand joints. Rheumatoid arthritis is characterized by symmetrical joint involvement, especially affecting the small joints of the hands and feet. In women in their 40s, this is a common and typical manifestation.

The pattern of bilateral joint pain and swelling is a key indicator for rheumatoid arthritis, distinguishing it from other conditions. Polymyalgia rheumatica, while it can cause pain, typically presents with proximal muscle stiffness and does not exclusively involve the small joints. Osteoarthritis usually presents with morning stiffness lasting less than 30 minutes and often demonstrates more asymmetrical joint involvement later in the disease progression. Ankylosing spondylitis primarily affects the spine and sacroiliac joints and is less common to present with hand joint involvement as an initial symptom.

Understanding these presenting features allows us to identify rheumatoid arthritis as the most probable diagnosis in this case.