QDC is a 43-year-old female goes to the doctor with swelling and pain in her lim
ID: 3507565 • Letter: Q
Question
QDC is a 43-year-old female goes to the doctor with swelling and pain in her limbs. She states that her other joints are “achy” and she has stiffness in the morning that makes it difficult for her to get going. QDC was diagnosed with rheumatoid arthritis (RA).
Physical Exam:
Height: 5’8" Weight: 175 lbs
Vital Signs: T 98.7F HR 72 BPM,
RR 16 BPM, BP 144/87 mmHg,
Pain: 8/10
Allergies:
Sulfa (swelling of the mouth and lips)
Labs:
WBC (4,000-11,000 cells/mm3) = 12,500
Plts (140,000-420,000/mm3) = 510,000
Hgb (13-18 g/dL) = 14.1
Hct (38-50%) = 36%
Rheumatoid factor (< 40 IU/mL) = 90
ESR (1-20 mm/hr) = 250
1. What is a rheumatoid factor (in relation to the diagnosis of RA)? What does it do, what is its role in the disease?
2. What soluble, noncellular molecules of the immune response are responsible for inflammation in the joint space of the rheumatoid synovium? Be specific.
3. Is sulfasalazine an appropriate choice of drug for this patient? Why?
4. Recommend an NSAIDS to the physician for the management of this patient.
Explanation / Answer
1. Rheumatoid factor is a protein produced by the immune system which can attach to other antibodies in the body and cause autoimmune disorders. This is caused by an anomaly in the immune system where the antibody cannot tell the difference between foreign antibodies and attacks body's own tissues.
Rheumatoid factor is usually present in patients suffering from rheumatoid arthritis or relatives of patients without the disease.
The normal range for rheumatoid factor is 15 IU/ml and any value above that is considered a positive test result.
2. Circulating autoantibodies such as rheumatoid factor and anti-citrullinated protein antibodies are responsible for the inflammation of the synovium.
3. Sulfasalazine is not an appropriate drug for this patient since the patient is allergic to sulfa drugs as seen in the test results.
4. Ibuprofen is a common NSAID which can be recommended to manage the arthritis in the patient.
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