MRCP2-4714

MRCP2-4714

A 29-year-old woman who is 20 weeks pregnant is referred to you by her GP. She has a 2-month history of arthralgia, myalgia, and fatigue. She had initially put this down to pregnancy but was finding it increasingly difficult to do her job as a health care assistant in a local nursing home. She denied any shortness of breath, swallowing difficulties or alopecia.

She had asthma since childhood but was relatively well controlled on inhaled salbutamol as required and beclomethasone 400 micrograms twice daily.

She was a smoker of 10 cigarettes per day and had not drunk any alcohol since learning she was pregnant. She lives with her husband and 2-year-old son. Her mother has a history of rheumatoid arthritis.

Her observations show a blood pressure of 138/86 mmHg and a heart rate of 92 beats per minute. Urinalysis showed a trace of protein.

On examination there was tenderness of the 2nd and 3rd metacarpophalangeal (MCP) joints bilaterally and both wrists but no evidence of active synovitis. There are several painless mouth ulcers. You notice a few bruises on her arms but no other evidence of a rash. Her chest was clear and heart sounds were normal. Neurological examination was normal including full visual fields and eye movements.

Her bloods showed the following:

Haemoglobin 108 g/L
White Cell Count 9.2 x 109/L
Platelets 103 x 109/L

Neutrophils 6.02 x 109/L
Lymphocytes 0.80 x 109/L
Eosinophils 0.90 x 109/L
ESR 29 mm/h

Urea 6.9 mmol/L
Creatinine 118 micromol/L
CRP 11 mg/L
Alkaline Phosphatase 87 iu/L

ALT 42 iu/L

Albumin 32 g/L

ANA 1: 320
dsDNA 24
Anti -Ro Positive
Anti -La Positive
Rheumatoid Factor Positive
Anti CCP Negative
Antiphospholipid antibody negative

What is the most likely diagnosis and what complication should be discussed with her?