A 46-year-old woman is evaluated for a 1-week history of symmetric polyarthritis of the hands, wrists, and knees, accompanied by a rash. She is a home health aide. She has no other pertinent history and takes no medications.
On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 118/72 mm Hg, pulse rate is 78/min, and respiration rate is 13/min. BMI is 22. There are symmetric tenderness, warmth, erythema, and swelling of the wrists, proximal interphalangeal and metacarpophalangeal joints, and knees bilaterally. Bilateral knee effusions are noted. There is mild right upper quadrant pain. A maculopapular rash over the trunk and legs is present.
Erythrocyte sedimentation rate | 63 mm/h |
Alanine aminotransferase | 1050 U/L |
Aspartate aminotransferase | 800 U/L |
Creatinine | Normal |
Which of the following is the most likely diagnosis?