Am Fam Physician. 2016 Sep 1;94(5):375-376.
A 77-year-old woman presented with a longstanding history of daily pain and stiffness in multiple joints. She reported morning stiffness in her shoulders, knees, dorsal feet, and metacarpophalangeal joints that improved with hot showers. She did not have acute attacks of pain or constitutional symptoms such as fever, chills, or weight changes.
On physical examination, she had symmetric swelling, warmth, and tenderness of the second, third, and fourth metacarpophalangeal joints. She also had bilateral irregularly shaped, nontender, firm, fixed nodules over the extensor surfaces of her elbows (Figure 1).
Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?
A. Epidermoid cysts.
B. Olecranon bursitis.
C. Rheumatoid nodules.
D. Tophaceous gout.
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This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.
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