“My hands are stiff and swollen — I’ll just take some ibuprofen”

Symmetrical small-joint (MCP/PIP/wrist) pain WITH swelling/synovitis and prolonged early-morning stiffness (>30 min) over weeks is an INFLAMMATORY pattern — likely early rheumatoid arthritis — NOT osteoarthritis/"wear and tear" (which worsens with use, stiffens only briefly, and favours larger/DIP joints). The examinable imperative is the "window of opportunity": early DMARD treatment prevents joint damage and disability, so NICE NG100 recommends URGENT rheumatology referral (within 3 working days, NICE QS33) for suspected persistent synovitis (especially small joints of hands/feet, >1 joint, or ≥3 months’ delay) — before bloods/X-ray results — rather than "NSAIDs and review", and a normal RF/CRP does NOT exclude RA (seronegative RA exists). Arrange baseline tests (FBC, ESR/CRP, RF, anti-CCP, hand/feet X-rays) and bridging symptom relief (NSAID + gastroprotection; a short steroid course only if agreed with rheumatology) without delaying referral, and flag work and fertility/pregnancy (methotrexate) considerations. The hidden agenda is a mother-driven disability fear ("ended up in a wheelchair") driving minimisation; surface it and reframe powerfully — modern early treatment changes the outcome, so catching it now is the opposite of her mother’s fate.