Review Question - QID 214183

A 28-year-old woman presents to the physician’s office with symmetric joint pains throughout her body. She states that she has never had these symptoms before, but recently began experiencing symmetric joint pain in her upper extremities that is worse in the morning and improved with exercise. Her joint pain is most notable in her hands and wrists. The patient is otherwise generally healthy. She states that she lives at home with her husband and son. She is stressed because her son is currently sick with a fever and has to accompany her throughout her daily routine (Figure A). Her mother has a history of rheumatoid arthritis, and her father suffers from osteoarthritis. Her temperature is 98.3°F (36.8°C), blood pressure is 122/82 mmHg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam including cardiopulmonary and dermatologic exam is unremarkable. Which of the following is the most likely etiology of this patient’s symptoms?