Review Question - QID 210847

A 47-year-old African American woman presents to her primary care physician with complaints of fatigue and joint stiffness for the past year. She reports that her joint stiffness is worse when she wakes up in the morning, but it is present throughout the day. She has no past medical history and takes no medications. Her temperature is 98.8°F (37.1°C), blood pressure is 146/92 mmHg, pulse is 86/min and regular, and respirations are 18/min. On physical exam the patient is noted to be wearing gloves, and she explains that her hands are often cold and painful. Examination of her hands without gloves shows her fingers are held in flexion bilaterally along with the findings in Figure A. Pulmonary examination is significant for bilateral inspiratory crackles. Which of the following is most likely to be additionally found in the patient?