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Ivan D. Camacho, MD; Isabel Valencia, MD; Maria P. Rivas, MD; Anne E. Burdick, MD, MPH

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Report of a Case

A 47-year-old Brazilian man presented to the rheumatology clinic with a 6-month history of joint pain and swelling of both hands and wrists. His medical history was unremarkable. Laboratory studies revealed elevated C-reactive protein levels (3.6 mg/L; normal, <1.0 mg/L) and erythrocyte sedimentation rate (26 mm/h; normal range, 0-10 mm/h). (To convert C-reactive protein to nanomoles per liter, multiply by 9.524.) Findings were negative for anticyclic citrullinated peptide antibody, rheumatoid factor, and hepatitis B and C antibodies. On physical examination, symmetric polyarticular swelling of the hands and wrist joints was noted. Radiologic examination revealed diffuse soft-tissue swelling of the wrists. A presumptive diagnosis of seronegative rheumatoid arthritis was made, and treatment was begun with prednisone, 10 mg/d, and methotrexate, 20 mg/wk. Five months later, the symptoms persisted, and 2 subcutaneous doses of adalimumab, 40 . . . [Full Text of this Article]

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