Question

Justine Belamo is a 48-year-old White female who has been married to Gil Belamo for 18 years. Justine has a daughter, Majel, from a previous marriage, and she has two teenage children (Mark and Maria) with Gil. Justine works as a grocery store clerk. Although she finds her job monotonous, she appreciates the steady income and family health insurance.

Justine is overweight and has tried to lose weight most of her adult life. She frequently diets and, in the past, has lost a great deal of weight, but she just can't seem to keep the weight off. She blames menopause for her most recent weight gain.

Question 1

What factors place Ms. Belamo at risk for development of RA?

Question 2

When talking with Ms. Belamo, what interview questions might you ask to determine if she has any early signs of RA?

Question 3

If Ms. Belamo were to be diagnosed with RA, what teaching might you provide to reduce joint damage?

Answer 1

Answer:1

The risk factors that place Ms. Belamo at risk for the development of RA:

1. Age - Risk for RA increases up to the age of 45 years, remains high between 45 to 75 yrs and later declines
2. Gender - Female gender is a risk factor for RA. The incidence of RA in women is 3.4/10,000
3. Overweight - women who are overweight have a high risk of RA
4. Menopause - Women with irregular menses and early menopause have high risk of RA
5. Stress - Stress is also a risk factor for RA

Answer:2

Early signs of RA are :

Clinical features:

1. Vague pain and fatigue
2. Prolong period of morning stiffness
3. Involvement of joints of the hands and feet
4. Involvement of metacarpophalangeal and metatarsophalangeal joint.
5. Swollen and painful joints
6. Symmetrical joint involvement

Laboratory test:

1. HLA-DRB
2. Rheumatoid factor positivity (RA factor) in the presence of undifferentiated arthritis
3. Anti- citrullinated factor (anti-CCP) in the presence of undifferentiated arthritis.
4. Increase levels of ESR and CRP

Imaging:

1. Synovitis
2. Soft tissue swelling  
3. juxta-articular osteoporosis ( the aforementioned radiological features are not seen on plain radiography but are evident on MRI and sonography)

Answer:3

Measures to reduce joint damage are:

1. Reduce weight
2. Regular exercise
3. Taking adequate rest during disease flare-ups
4. Quit smoking
5. Stress reduction
6. Initiating medicines early in the course of the disease ( disease-modifying agents, steroids, biological agents)
7. Using a combination of DMARDs ( hydroxychloroquine and methotrexate)
8. Using a combination of DMARDs and steroids.