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Chronic Illness in Women

Chronic Illness in Women

Sample Answer 

Chronic Illness in Women

What Is Your Differential Diagnosis for This Patient?

Diagnosis: Rheumatoid arthritis

Differentials: Osteoarthritis, psoriatic arthritis, polyarticular gout or acute viral polyarthritis, calcium pyrophosphate deposition disease, and systemic lupus erythematosus (SLE)

What Diagnostic Studies Are Warranted for This Patient?

Rheumatoid arthritis (RA) diagnosis can be made by using some manifesting clinical features. These features include a positive rheumatoid factor (RF); Inflammatory arthritis where three or more joints are involved; and/or anti-citrullinated peptide/protein antibody (for example, the anti-cyclic citrullinated peptide [CCP]) testing); erythrocyte sedimentation rate (ESR) or Elevated levels of C-reactive protein (CRP) (Plaza et al., 2016).

Blood tests can also be conducted where a person with RA will show an elevated C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR).

Imaging tests may be recommended to help track the RA progression in the joints over time. The imaging results will help in determining disease severity.

What Is the Patient’s Calculated American College of Rheumatology/European League Against Rheumatism (ACR/EULA) Score?

According to the ACR/EULA score, 1 to 3 small joints (from the wrist, among the proximal interphalangeal joints, metacarpophalangeal joints, second through fifth metatarsophalangeal joints, and thumb interphalangeal joints), the score for this patient is at 2 points

What Is the Treatment for This Patient?

The patient will be prescribed different treatments based on the severity of the illness. The first line of treatment is the nonsteroidal anti-inflammatory drug (NSAID) (Kudrina, Shir, & Fitzcharles, 2015). These medications will help reduce inflammation and pain though they will not slow the RA. The second line will be DMARDs (disease-modifying anti-rheumatic drugs). These help slow or stop RA from worsening (Benjamin & Lappin, 2019). In this category, the patient may be prescribed methotrexate. However, if this fails in effectiveness, a different type of DMARD may be added to curtail the inflammation. A third option is the biologic agents, also called biologic response modifiers. These agents can target specific immune system areas that are inflammation triggers and cause tissue and joint damage (Schaeverbeke et al., 2016).

References

Benjamin, O., & Lappin, S. L. (2019). Disease modifying anti-rheumatic drugs (DMARD). In StatPearls [Internet]. StatPearls Publishing.

Kudrina, I., Shir, Y., & Fitzcharles, M. A. (2015). Multidisciplinary treatment for rheumatic pain. Best Practice & Research Clinical Rheumatology29(1), 156-163.

Płaza, M., Nowakowska-Płaza, A., Pracoń, G., & Sudoł-Szopińska, I. (2016). Role of ultrasonography in the diagnosis of rheumatic diseases in light of ACR/EULAR guidelines. Journal of ultrasonography16(64), 55.

Schaeverbeke, T., Truchetet, M. E., Kostine, M., Barnetche, T., Bannwarth, B., & Richez, C. (2016). Immunogenicity of biologic agents in rheumatoid arthritis patients: lessons for clinical practice. Rheumatology55(2), 210-220.

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Question 


Chronic Illness in Women

Discussion Topic 15 (Chronic Illness in Women)

***The initial discussion response should be in the range of 250-300 words. All questions in the topic must be addressed. All discussions need to be supported by a minimum of two scholarly resource. Journals and websites must be cited appropriately (Citation and reference must adhere to APA format). All components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Case Study:

Mrs. Dora Gray is a 47-year-old patient who presents to the clinic for evaluation of hand and wrist pain. She first noticed her pain located in the wrist that began about 2 months ago that is worse at work or during texting. She is an administrative assistant and responsible for the office typing. As a result of her responsibilities, she thought she had carpal tunnel syndrome. About 3 weeks ago, she purchased a wrist brace from the local pharmacy store wearing it all day. She relates no relief in her pain while wearing the wrist brace. She is concerned now that the pain has been radiating to her fingers. An associated symptom with her presentation is stiffness in the wrists predominantly in the morning lasting for about 2 hours. In an attempt to improve the pain, she started taking naproxen with mild pain improvement but no change in the morning stiffness. She has missed the last 3 days of work due to worsening stiffness and pain. Denies any trauma to the affected area. Denies loss of sensation in her fingers.

Chronic Illness in Women

Chronic Illness in Women

Mrs. Gray remembers that her grandfather has a history of rheumatoid arthritis. She does report smoking one pack of cigarettes per day for the past 28 years. She denies any hospitalizations, blood transfusions, trauma, or travel outside the United States.

Examination:

  • Physical Exam Heart: Regular rate and rhythm, 2+ pulses in upper and lower extremities
  • Lungs: Clear throughout bilaterally with equal rise and fall of the chest
  • Extremities: first, third, and fifth metacarpophalangeal (MCP) joints are warm with decreased range of motion due to pain. Right and left wrist with generalized swelling, warm to touch with associated pain with passive flexion at ~50°.
  • Skin: No rash
  • Remainder of Physical Exam is unremarkable.

Questions:

  1. What is your differential diagnosis for this patient?
  2. What diagnostic studies are warranted for this patient?
  3. What is the patient’s calculated American College of Rheumatology/European League Against Rheumatism (ACR/EULA) score?
  4. What is the treatment for this patient?

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

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