Clinical presentation

In 2002 a 73-year-old woman (non-smoking, medical history of allergic rhinitis) was referred to a rheumatologist because of synovitis of the metacarpophalangeal and proximal interphalangeal joints of both hands which had slowly developed over 3 months. Late-onset rheumatoid arthritis was suspected. Morning stiffness, rheumatoid nodules, erosions of cartilage or bone, rheumatoid factor and antibodies to cyclic citrullinated peptides were absent. Prednisone (2.5–5 mg daily) and non-steroidal anti-inflammatory drugs were started.

In 2004 she was referred …