Question

List two possible pathologies that could be causing the patients signs and symptoms (this is called a differential diagnosis list)

3) Explain what test or tests should be preformed on the patient in order to determine which pathology is the proper diagnosis

4) Pick one of the possible pathologies that you listed and describe what the treatment and prognosis would be

Case Study - Week 5

A 62 year old female presents with joint pain and swelling that started 2 weeks ago and has been gradually getting worse. She has noticed that she occasionally gets a slight fever and has been feeling fatigued lately.

Answer 1

Diffetential diagnosis/ Possible pathologies

Symptoms: joint pain, swelling, slight fever occasionally, fatigue

Pathologies

1. Rheumatoid arthritis(RA)

2. Chickungunya

3. Osteoarthritis

3. Diagnostic Evaluation

Clinical History: personal history, medical and surgical history( past and present), duration of joint pain and swelling, recent travel history

Physical examinations : to check for swelling, deformity and functional disability

X- rays or MRI scans: to know the type of arthritis and the progress

Blood tests:

ESR( not specific for RA. It helps to detect the level of inflammation in the body)

C- reactive protein( CRP); high level of CRP, produce by liver indicates high level of inflammation. Not specific for RA

Rheumatoid factor; positive sign of RA is indicated by the presence of an antibody factor known as rheumatoid factor.

Haemoglobin level; RA patients may also have anaemia.

Joint aspiration; to detect any infection in the joint fluid or uric acid crystals

ELISA; to confirm the presence of Chickungunya antibodies IgM and IgG.

4. Rheumatoid arthritis

It is an autoimmune disorder . It is characterised by pain, inflammation and swelling of the joints, weakness, stiffness and loss of mobility and deformity and fatigue.

Treatment

No cure for RA, but treatment will help to reduce symptoms.

Nonsteroidal anti-inflammatory drugs( NSAIDs): to reduce inflammation

Ex: Advil, Aleve

Corticosteroids: to reduce pain and inflammation and joint damage

Disease- modifying antirheumatic drugs( DMRDs): to reduce the progress of joint damage

Ex: methotrexate, sulfasalazine, minocycline

Tumour necrosis factor-alpha inhibitors( TNF- alpha inhibitors)

To prevent inflammation and stiffness

Ex: infiximab, adalimumab

Surgery

People with permanent damage that limits daily function can opt for surgery to repair damaged joints, correct deformities. Ex: tendon repair, Arthroplasty

Occupational therapy will help a person to learn new and effetve ways of carrying out daily tasks. Occupational therapists will involve in the care.

Home remedies

Proper rest , exercise, diet( more vegetables and fruits), relaxation techniques and hot or cold application can be given . Taking a 15 minute hot bath or shower can be helpful for relieving the pain.

Prognosis.

No cure for RA. But treatment can help to reduce symptoms.