Question

A 27-year-old white female seeks medical attention because of persisting pain in her wrists and ankles and an unexplained skin irritation on her face. On physical examination, swelling of the joints of the hands and ankles is evident, along with erythema of the skin over the bridge of the nose and the upper cheeks. The patient has a slightly elevated temperature.

Laboratory Data:

The following laboratory tests are ordered: CBC, urinalysis (UA), and rheumatoid arthritis screening test(RF). Results are as follows:

Hgb & Hct: normal

WBC count: normal

Differential: normal

Gross and microscopic UA: normal

Rheumatoid arthritis screening test: positive

Follow-up:

An ANA screening test is ordered. The results are positive.

Questions:

1. What is the most probable diagnosis in this case?

2. Does this patient fit into the general characteristics of patients with this disease?

3. What is the principle of the ANA test?

Answer 1

Answer :

Based on the above scenario, the patient is suffering with rheumatoid arthritis .

• It is a chronic inflammatory disease of unknown etiology marked by symmetric , peripheral polyarthritis.

Clinical features :

• Incidence : between 25 to 55 years of age .
• The presenting symptom resulting from inflammation of the joints ,tendons ,and burse.
• Early morning joint stiffness lasting more than 1 he that eases with physical activity.
• Earliest involved joints - small joints of hands and feet .
• Rheumatoid arthritis have a higher number of tender and swollen joints ,test positive for serum rheumatoid factor and anti -CCP antibodies and have higher score for physical disability.
• Wrist ,MCP and PIP joints stand ,most frequently involved joints .
• DIP joints : rarely involved and denotes co existent osteoarthritis.
• Flexor tendon tenosynovitis - a hallmark of RA.

2) answer :

She is having positive rheumatoid factor ,so prognosis is poor .

• Early RA : disease duration less than 6 months .
• Established RA : disease duration > months or meeting the classification criteria
• Disease activity : low , moderate and high .
• Poor prognosis : functional limitation , extra articular disease , positive rheumatoid factor ,bony erosions by radiography.

3) answer :

Observation of a specific pattern of fluorescence on the HEp- 2 cells indicates the presence of autoimmune of antibodies in the patients serum .tigers are done on positive specimens .the test for antinuclear antibodies is a good screening test for autoimmune disorders .