Question

B.T. is a 42-year-old woman who complains of increasing joint pain and stiffness in her hands, wrists, shoulders, and knees. She has been taking aspirin every 4 to 6 hours with little relief. Her physician suggests x-ray and blood studies to evaluate her joint dysfunction.

1. Considering the distribution of B.T.’s joint dysfunction and her age, what is the most likely cause of this dysfunction? What additional history or physical assessment data would support this diagnosis?

2. What laboratory tests would be helpful in confirming this diagnosis?

3. B.T.’s physician orders low-dose steroid therapy (prednisolone) as part of the treatment plan. What is the rationale for using this drug?

4. What other measures would be indicated in the management of BT’s disorder?

Answer 1

1. The most possible cause is Rheumatoid arthiritis. The condition is distinctly characterized by stiffness of hands, wrists, shoulders, and knees (joints). The additional assesment data required is as follows:

* familial history of RA

* how long the symptoms are present

* presence of any other associated symptoms like fatigue, weight loss or obesity

* Presence of signs like warmth, swelling, and tenderness

* presence of fluid on the joint

* range of motion of joints

* presence of rheumatoid nodules

2. Specific laboratory tests are not available for diagnosis of RH. Diagnosis is based on symptoms and ruling out the possibility of other similar conditions. Examination of medical history and physical assessment is more useful in diagnosis.

Diagnosis of further based on the following :

* Anti-cyclic citrullinated peptide antibody in the serum

* C-reactive protein levels in serum

* ESR

* Detection of rheumatoid factor

Other helpful tests are

* Bone density

* WBC

*MRI imaging of specific joints

* Joint fluid analysis

* antinuclear antibody assay (which is suspected to be the cause of immunecomplexes associated with RA).

3.

Treatment: Use of steroid durgs

Prednisolone: suppress inflammation, but assocaited with several side effects

4. Measures: Avoid stepping up or climbing, avoid repeated sitting and standing.