Skip to Main Content

++

INTRODUCTION

++

CASE LEARNING OBJECTIVES

  • Discuss the comorbidities associated with rheumatoid arthritis (RA)

  • Recognize the typical clinical presentation of RA

  • Create treatment goals for a patient with RA arthritis on the basis of global disease activity

  • Compare and contrast the available pharmacotherapeutic options, selecting the most appropriate regimen for a given patient

  • Propose a patient education plan that includes nonpharmacologic and pharmacologic treatment measures

  • Formulate an initial prescreening and a long-term monitoring plan to evaluate the safety and efficacy of a therapeutic regimen designed for an individual patient with RA

++

PATIENT PRESENTATION

++

Chief Complaint

++

"I'm stiff and my joints are swollen."

++

History of Present Illness

++

Ching Li is a 55-year-old postmenopausal woman presenting to the rheumatologist for evaluation and treatment of RA. CL presented to her primary care physician 3 months ago with complaints of symmetrical joint pain in her hands and feet and morning stiffness lasting more than an hour. She tried ibuprofen followed by naproxen for about 2 months with limited pain relief. During a follow-up visit with her primary care physician approximately 1 month ago, naproxen was discontinued and low-dose corticosteroids were initiated. The corticosteroids have helped joint discomfort partially, but have not had an impact on joint swelling. She reports significant difficulty with dressing (especially buttons, zippers, and tying her shoes) and meal preparation. She has experienced progressive morning stiffness, now lasting for 2–3 hours daily. She reports that she feels down, but does not understand why. Her husband passed away 3 years ago and, in her opinion, she dealt with her husband's passing immediately after his death.

++

Past Medical History

++

Peptic ulcer disease diagnosed 7 months ago

++

Hypertension × 3 years

++

Blood transfusion following C-section in China 30 years ago

++

Menopause at age 50

++

Family History

++

Father had CAD and died of MI at age 82. Mother died at age 70 from hepatocellular carcinoma. Her only brother has dyslipidemia and hypertension. Daughter is alive and well.

++

Social History

++

CL, a homemaker, moved to the United States from China to live with her daughter 3 years ago after her husband died. She speaks Mandarin and English. Her husband was employed by an international brokerage firm prior to his death and she has health insurance/prescription coverage available as part of his employment benefits.

++

Tobacco/Alcohol/Substance Use

++

(+) Tobacco 1 ppd × 40 years; (−) alcohol or illicit drug use

++

Allergies/Intolerances/Adverse Drug Events

++

Trimethoprim/sulfamethoxazole—rash

++

Medications (Current)

++

Hydrochlorothiazide 12.5 mg PO daily

++

Prednisone 5 mg PO daily in the morning

++

Lansoprazole 30 mg PO daily

++

Red ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.