system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 55-year-old woman presents to the clinic with joint pain and swelling of her hands. She reports that the pain lasts for about an hour in the morning and improves as her joints ‘loosen up’. This condition has been bothering her for about 2 years but has recently been impacting her daily routine. She has not seen a doctor in years. Past medical history is significant for hypertension and she takes hydrochlorothiazide daily. Her grandmother and aunt both had rheumatoid arthritis. She is a current smoker and has smoked a half of a pack of cigarettes a day for the last 20 years. The temperature is 37°C (98.6°F), the blood pressure is 125/85 mm Hg, the respiratory rate is 17/min, and the heart rate is 98/min. Physical examination reveals tender swollen joints in her hands and wrists. Laboratory work is presented below:
Hemoglobin 10.7 g/dL
Hematocrit 37.5% 
Leukocyte count 1,400/mm3
Mean corpuscular volume 81.4 μm3
Platelet count 200,000/mm3
Erythrocyte sedimentation rate 45 mm/h
Anti-citrullinated protein antibody 55 (normal reference values: < 20)
CT findings reveal osteopenia and erosions in the metacarpophalangeal joints. The patient is started on methotrexate. Which of the following is likely to be found in the synovial fluid analysis?
assistant
Ragocytes