Case Study: Rheumatoid Arthritis in a 42-year-old Female

Patient: Sarah Jones, a 42-year-old female accountant.

Presenting Complaint: Ms. Jones presents with a three-month history of progressive pain, stiffness, and swelling in her hands, wrists, and knees. The pain is worse in the mornings and improves slightly with activity. She reports difficulty gripping objects and climbing stairs due to knee pain. She also complains of fatigue and a low-grade fever most evenings.

Past Medical History: Unremarkable.

Family History: Mother diagnosed with rheumatoid arthritis at age 50.

Social History: Non-smoker. Drinks one glass of wine occasionally. Works full-time as an accountant.

Medications: None currently.

Physical Examination:

• Vital Signs: Blood pressure 138/80 mmHg, heart rate 88 bpm, temperature 99.0°F (37.2°C)
• General: Appears fatigued but in no acute distress.
• Musculoskeletal: Bilateral tenderness, swelling, and warmth in the wrists, metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints, and knees. Limited range of motion in wrists and knees.
• Other: No rashes or joint deformities noted.

Laboratory Tests:

• Anti-CCP (cyclic citrullinated peptide) antibody: Positive (high titer)
• Rheumatoid factor (RF): Positive
• Erythrocyte sedimentation rate (ESR): Elevated
• C-reactive protein (CRP): Elevated
• Complete blood count (CBC): Normal
• X-rays: Mild joint space narrowing in MCP and PIP joints of hands.

Diagnosis: Rheumatoid Arthritis

Discussion:

Ms. Jones presents with classic symptoms of rheumatoid arthritis (RA), an autoimmune disease causing chronic inflammation of the joints. Her morning stiffness, symmetrical joint pain, and positive serological tests (anti-CCP and RF) strongly suggest RA. X-rays, while not definitive for early RA, show mild joint space narrowing which can be a developing feature.

Treatment Plan:

• Disease-modifying antirheumatic drug (DMARD): Methotrexate will be initiated as the first-line DMARD to slow disease progression and prevent joint damage.
• Nonsteroidal anti-inflammatory drug (NSAID): Ibuprofen will be prescribed for pain relief and inflammation.
• Physical therapy: Occupational and physical therapy will be recommended to improve joint function and maintain strength.

Prognosis:

Rheumatoid arthritis is a chronic disease with varying degrees of severity. Early diagnosis and treatment with DMARDs can significantly improve the prognosis and help prevent joint damage and disability. Ms. Jones will require regular follow-up appointments to monitor her disease activity and adjust treatment as needed.

Additional Considerations:

• Patient education: Ms. Jones will be educated about RA, its management, and the importance of medication adherence.
• Supportive measures: Referral to a support group may be beneficial for coping with the emotional aspects of living with a chronic illness.
• Monitoring for complications: Regular monitoring for RA complications like infections and osteoporosis will be crucial.

This case study is a fictional example to illustrate the presentation, diagnosis, and treatment of rheumatoid arthritis.