Family Nurse Practitioner Exam

Mrs. Green is complaining of morning stiffness in her wrists and hands. What is the most likely diagnosis?

1. Osteoporosis

2. Rheumatoid arthritis

3. Osteoarthritis

4. Gout

The correct answer is: Rheumatoid arthritis

Morning stiffness in the wrists and hands is a characteristic symptom associated with rheumatoid arthritis. This condition is an autoimmune disorder where the body's immune system attacks the synovial membranes, leading to inflammation, pain, and stiffness in the joints, particularly after periods of inactivity, such as overnight sleep. The involvement of the wrists and hands specifically points toward a systemic condition like rheumatoid arthritis, which commonly affects these joints symmetrically and tends to worsen with immobility. The duration and timing of the stiffness, typically lasting more than an hour in the morning, further supports this diagnosis. Other conditions, such as osteoarthritis, primarily cause stiffness that is transient and improves with movement; osteoporosis is related to bone density and does not typically present with joint stiffness; and gout usually presents with acute pain, swelling, and redness, often in the big toe first, rather than generalized morning stiffness in multiple joints. Understanding these nuances helps clarify why rheumatoid arthritis is the most appropriate diagnosis in this scenario.