A 32 year old patient reports a 6-month history of intermittent symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more. What is the most likely diagnosis?

The symptoms described in the scenario are highly indicative of rheumatoid arthritis (RA). The patient is experiencing a 6-month history of symmetrical swelling in the wrists, which is a hallmark of RA, as the condition typically affects both sides of the body in a symmetrical manner. Additionally, morning stiffness lasting for one hour or more is another classic symptom associated with rheumatoid arthritis. This stiffness often improves with activity, which also aligns with RA characteristics.

In contrast, osteoarthritis typically presents with asymmetrical joint involvement and may not result in significant morning stiffness lasting longer than 30 minutes. Gouty arthritis generally presents with acute, unilateral joint swelling and intense pain, often starting in the big toe, rather than with symmetrical swelling of the wrists over a prolonged period. Reiter's syndrome, or reactive arthritis, is usually associated with a recent infection and often includes symptoms such as conjunctivitis and urethritis along with joint symptoms, which are not mentioned in this case.

Thus, considering the combination of the patient's age, the nature of the joint involvement, and the specific symptoms reported, rheumatoid arthritis is most consistent with this clinical presentation.