A 29-year-old man presents to you with a 10-week history of joint pain.

A 29-year-old man presents to you with a 10-week history of joint pain. His mother has severe rheumatoid arthritis (RA). On examination, he has 20 swollen joints and 30 tender joints. Laboratory test results include the following: mild normochromic anemia (hemoglobin 12.1 g/dL), elevated erythrocyte sedimentation rate (39 mm/h), negative rheumatoid factor test (14 international units/mL, reference range units/mL), weakly positive antinuclear antibody (ANA) test (1.2 units, reference range an increased level of antibodies to cyclic citrullinated peptide (anti-CCP) (>100 units, reference