Rheumatoid Arthritis: Diagnoses and Basic Treatments
A 32-year-old nurse presents to your office with a complaint of intermittent episodes of pain, stiffness, and swelling in both hands and wrists for approximately 1 year. The episodes last for several weeks and then resolve. More recently, she noticed similar symptoms in her knees and ankles. Joint pain and stiffness are making it harder for her to get out of bed in the morning and are interfering with her ability to perform her duties at work. The joint stiffness usually lasts for several hours before improving. She also reports malaise and easy fatigability for the past few months, but she denies having fever, chills, skin rashes, and weight loss.
What is the probable diagnosis?
What are other possible diagnoses?
At this stage of the case study, what diagnostic studies and basic treatments are most appropriate to order and why?
Health, Medicine, and Nursing
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Health, Medicine, and Nursing
Rheumatic diseases are those that emanate from any issue to do with the connective tissue. They are typically characterized by inflammation of the affected area. The clinical features of these diseases include a significant amount of pain in the joints and muscles, renal dysfunction, fever, a general feeling of fatigue, and to a certain extent, weight loss. In the case provided, there is quite a high chance that rheumatoid arthritis is the most probable diagnosis, as the manifestation that the patient presents points to this diagnosis. The other possible diagnosis may include osteoarthritis, gout, ankyloses spondylitis, fibromyalgia, bone cancer, and Paget’s disease.
The pattern of joint movement can play an important role in coming up with the exact diagnosis of the ailment. For instance, inflammatory pain is one characterized by joint pains that are worse in the morning and a longer period of stiffness but then ease off as the day goes by. The degenerative one happens when the pain gets worse as an individual engages in certain activities and has a short period of stiffness. The location of the pain also provides a clue about the type of disease. If the pain is localized to the small joints of the hands as well as the feet, then there is a high chance that it is an autoimmune rheumatic disease.
The diagnostic studies for Rheumatoid Arthritis should adhere to certain criteria. The criteria include morning stiffness not only in but also around the joints, and it lasts at least one hour before improvement and the swelling of soft tissues of three or more joint areas. Others entail swelling of the wrist joints or proximal interphalangeal, metacarpophalangeal, rheumatoid nodules, symmetric swelling, the presence of Rheumatoid factor, and periarticular osteopenia or radioactive erosions in the wrist joints or hand. Criteria one to four should be present for about six weeks. The disease is considered present because of the presence of at least four of the abov...