Rheumatoid arthritis case study
Rheumatoid arthritis case studyCPT3 2014Sarah Chai 1104039Ashley
GrahamJodian FrancisCarla Samuels Patrice CobourneStephanie Clarke
CalvertOnika Davis
Objectives Identify the signs and symptoms of rheumatoid
arthritis (RA) and assess disease severity.Recommend appropriate
nonpharmacologic options for adjunctive management of RA.Recommend
appropriate disease-modifying drug therapy for RA and monitor
patients effectively to achieve desired therapeutic
outcomes.Understand the role of analgesic and antiinflammatory
medications in managing RA.Educate patients and their families
about the medications used to treat RA.
Patient presentationChief ComplaintI ache all over, I feel
exhausted, and I am having a hard time getting going in the
morning. I want to have a baby, but I dont think I can do it
feeling like this.HPIIrene Schwartz is a 33-year-old woman who
presents to rheumatology clinic with generalized arthralgias,
fatigue, and morning stiffness. She presented with similar symptoms
3 months ago, at which time she was started on naproxen and a
regimen of oral methotrexate. She reports a slight improvement in
her symptoms relative to her visit 3 months ago.PMHRA 3
monthsFHFather is alive and is being treated for hypertension and
dyslipidemia. Mother is alive with severe RA and osteoporosis. Two
siblings with no major health concerns.SHExecutive secretary;
married for 3 years; wants to start a family within the next year.
Denies tobacco use. Drinks one to two glasses of wine per
week.Patient presentationMedsNaproxen 500 mg po twice
dailyMethotrexate 2.5 mg, six tablets (15 mg) po once a weekFolic
acid 1 mg po once dailyPatient receives medications at a local
community pharmacy. Medication profile indicates that she refills
her medications on time the first of each month.AllNoneROSComplains
of swelling and pain in both hands; reports decreased ROM in hands
and wrists. Has morning stiffness every day for about 2 hours and
fatigue daily during the afternoon hours. Denies HA, chest pain,
SOB, bleeding episodes, or syncope; no nausea, vomiting, diarrhea,
loss of appetite, or weight loss.
Patient presentationPhysical ExaminationGen - Caucasian woman in
moderate distress because of pain, swelling, and fatigue related to
arthritisVS - BP 118/76 mm Hg, P 82 bpm, RR 14, T 37.1C; Wt 65 kg,
Ht 56Skin - No rashes; normal turgor; no breakdown or ulcers; no
subcutaneous nodulesHEENT - Normocephalic, atraumatic. Moist mucous
membranes; PERRLA; EOMI; pale conjunctiva bilaterally; TMs intact;
no oral mucositisNeck/Lymph Nodes - Neck supple, no JVD or
thyromegaly; no thyroid bruit; no lymphadenopathyChest - CTABreasts
- DeferredCV - RRR; normal S1, S2; no MRGAbd - Soft, NT/ND; (+)
BSGenit/Rect - Deferred
Patient presentationMS/ExtTotal of 16 tender and swollen joints
bilaterally.Hands: swelling and tenderness on palpation of second,
third, fourth, and fifth PIP and MTP joints bilaterally; decreased
grip strength, L > R (patient is left-handed)Wrists: decreased
ROMElbows: good ROMShoulders: decreased ROM (especially abduction)
bilaterallyHips: good ROMKnees: good ROM, no pain bilaterallyFeet:
no obvious swelling of MTP joints. Full plantar flexion; reduced
dorsiflexion; 2+ pedal pulsesNeuroCN IIXII intact; muscle strength
4/5 UE, 4/5 LE, DTRs 2+ throughout
Patient presenation - labsNa 135 mEq/LHgb 10.8 g/dLAST 15
IU/LCK
