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MKSAP 18 Q & A
A 43-year-old man is evaluated for knee, hip, shoulder, and arm stiffness, worsening over the past year. He also has pain in the arms, legs, neck, and torso, both on and between the joints. He states that his discomfort is continuous. He also reports chronic fatigue, lack of sleep, a band-like headache, and difficulty concentrating. He also has intermittent constipation and diarrhea. He takes acetaminophen and ibuprofen as needed for pain without much benefit.
On physical examination, the patient appears tired and anxious, with no acute distress. Vital signs are normal. He has minimal tenderness on palpation of multiple muscle groups. Full range of motion of all joints without crepitus is noted. There is no joint swelling or rash.
Laboratory studies, including complete blood count, erythrocyte sedimentation rate, serum creatine kinase, and thyroid-stimulating hormone, are within normal limits.
Which of the following is the most likely diagnosis?
D: Rheumatoid arthritis