Question

Tiffany, 36-year-old woman who has been experiencing of pain and swelling in her hands and feet. On examination by her General Practitioner (GP) her hands and feet display evidence of inflammation; rubra, heat and swelling and decreased function. On palpation and movement, they cause considerable pain which she rates as 5 - 7 on pain scale of 0 -10. When questioned on when this pain and inflammation first started, she is unable to say, but it has gradually worsened over the past 4 weeks. She states she has been taking Ibuprofen which initially provided relief but is no longer as effective. It is worse in the morning and she is now unable to carry out her many aspects of her normal routine. Her GP suspect’s Rheumatoid Arthritis (RA).

Questions:

3a.       Discuss the pathogenesis of Rheumatoid arthritis and link it to the clinical manifestations that Tiffany is experiencing.                                                        4 marks

3b.       Discuss the diagnostic tests that may be used in the diagnosis of RA

3 marks

3c.       Disease Modifying Anti Rheumatic Drugs (DMARD) are often the first line of pharmacological therapy despite the significant side effects. Name two non-biological DMARD’s, describe how they work and why they are prescribed despite the significant adverse drug reactions (ADR’s)                                                                                                 3 marks ( 1 mark for drug names, 2 marks for discussion)

Answer 1

Rhuemathoid arthitis is an inflammatory autoimmune disease with both articular and systemic effects. Its cause is unknown it can be genetic and environmental factors.
The 4 stages of

• Stage 1: Early RA
• Stage 2: Antibodies Develop and Swelling worsens
• Stage 3: Symptoms Will be Visible
• Stage 4: Joints Become Stiff.
  

• The pathogenesis of RA is not completely known it can mostly be some external trigger (eg, cigarette smoking, infection, or trauma) that sets off an autoimmune reaction, leading to synovial hypertrophy. Synovial cell hyperplasia and endothelial cell activation are early events in the pathologic process that progresses to uncontrolled inflammation. Genetic factors can also affect

When compared to the conditions of the patient, she has pain and swelling in her hands and feet and also evidence of inflammation is present and also she has no pain and has general body stiffness in the morning.

The diagnostic tests are

erythrocyte sedimentation rate (ESR, or sed rate) Patients can have elevated ESR rate

or C-reactive protein (CRP) Patients can have high CRP rate it commonly indicates man inflammatory process in the body

Other common blood tests are  anti-cyclic citrullinated peptide (anti-CCP) antibodies