A 45-year-old female presents to their GP with a 3-month history of joint pain and morning stiffness. The symptoms started gradually and primarily affect the small joints of the hands and wrists. They describe the stiffness as lasting for over an hour each morning. The pain improves slightly with activity but worsens by the end of the day. They also report feeling fatigued. On examination, there is bilateral swelling and tenderness of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, with reduced grip strength. There are no obvious deformities, and the joints are not erythematous.