A 42 y old woman presented with pain, swelling, and stiffness in the hands and feet. She reported having had the symptoms for the previous 5 years and was treated with NSAIDs and prednisone. O
n examination, the patient had dactylitis of the 2nd & 3rd fingers of the right hand and the 5th finger of the left hand. The 2nd & 4th toes of both feet were swollen. The ESR and level of ACE were elevated. Test results for RF and antiCCP antibodies were negative. Radiographs of the hands and feet showed several circumscribed, corticated lytic bone lesions. Cystic radiolucent areas along with extensive bone erosions with pathologic fractures were also seen.
Which of the following is the most likely diagnosis?
a) Psoriatic Arthritis
b) Rheumatoid arthritis
c) Paraneoplastic syndrome
e) Progressive pseudorheumatoid dysplasia