Case 4: Introduction

Case Published: November 2022

History of Present Illness (HPI) clipboard
27-year-old woman presents to the primary care clinic with pain in her hands for the past three months. She works as a barista and noticed that she is struggling with her tasks for a few hours in the morning as her hands feel “fat” and difficult to move. After several hours of fighting with the espresso machines, opening and closing her fist, and putting her hands in warm water, she notices better mobility and dexterity. She tried Tylenol for pain which did not help at all. When she takes a nap during a day off, she notices her hands get hard to move again and it takes about an hour to regain dexterity.

No other joints are bothering her. She has not been sick recently herself and has not been around sick children – they are not socializing with other families indoors due to concern for COVID. No fevers, chills, night sweats. No rashes.

She delivered a healthy baby girl 4 months ago. No issues with pregnancy. She is not breastfeeding. She is wondering if her symptoms are due to not sleeping well enough as a new mom. She is adopted but knows her biological mother suffered from some sort of arthritis since early adulthood. No other family history is known. She has never smoked, has not drank alcohol since before becoming pregnant, has never used any recreational drugs. She takes only prenatal vitamins. Lives with her husband, newborn, and an elderly corgi. It has also been hard to take care of the baby and the dog due to her hand issues. She has not traveled anywhere for years. She has had a negative screening hepatitis C test at the beginning of her pregnancy.

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