SHM Converge Scientific Abstract ePoster Gallery-When the Labs Speak Louder Than the X-Rays: A Seropositive Rheumatoid Arthritis Flare Case

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This case describes a 47-year-old woman with a history of breast cancer, chemotherapy, radiation, and carpal tunnel syndrome who presented with 5 days of acute inflammatory joint pain and swelling involving the left hand, wrist, MCP and PIP joints, bilateral knees, ankles, and right foot. She also reported fatigue. She was afebrile and hemodynamically stable, but exam showed significant tenderness, swelling, and inability to make a fist. Labs showed elevated inflammatory markers and strongly positive serologies: RF 197, anti-CCP 300, and ANA 1:640. X-rays of the hand and knees were normal.<br /><br />The presentation was concerning for new-onset seropositive rheumatoid arthritis. This case highlights that RA is usually diagnosed in the outpatient setting, but severe symptoms can require hospitalization. Importantly, early disease may have normal radiographs; only 30–40% of seropositive patients have bone changes at presentation, while erosions may develop in up to 70% within 12 months. Thus, diagnosis relies primarily on clinical features supported by laboratory testing rather than x-ray findings alone.<br /><br />Management began with NSAIDs for symptom relief, followed by a prednisone taper from rheumatology, which led to significant improvement. The case emphasizes a stepwise approach: control acute inflammation with NSAIDs and corticosteroids, then quickly start disease-modifying antirheumatic drugs, with methotrexate as first-line therapy. The treat-to-target strategy aims for early, aggressive control of disease activity to prevent irreversible joint damage and deformity. Because seropositivity is associated with worse prognosis, earlier escalation to biologic therapy may be needed in some patients.

Asset Subtitle

Mallorie Vest

Meta Tag

Author List Luke Vest, Mallorie Vest

Category Clinical Vignettes

Concept Rheumatoid Arthritis

Concept Polyarthritis

Concept Disease-Modifying Antirheumatic Drug

Concept Methotrexate

Concept Targeted strategy

Distinguished Non-Finalist

Presenter Organization Washington University School of Medicine

Presenting Author Mallorie Vest

Track Adult

Keywords

rheumatoid arthritis

seropositive

anti-CCP

rheumatoid factor

joint swelling

inflammatory markers

prednisone

NSAIDs

methotrexate

treat-to-target

Rheumatoid Arthritis

Polyarthritis

Disease-Modifying Antirheumatic Drug

Methotrexate

Targeted strategy