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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Identify signs and symptoms of rheumatoid arthritis (RA) and assess disease severity.

  • Recommend appropriate nonpharmacologic therapy for adjunctive management of RA.

  • Recommend evidence-based, patient-specific analgesic, anti-inflammatory, and disease-modifying drug therapy for patients with RA.

  • Develop an evidence-based, patient-specific monitoring plan to assess disease progress and evaluate the safety and efficacy of medication therapy.

  • Educate patients and their families about the medications used to treat RA.

PATIENT PRESENTATION

Chief Complaint

“Lately I am very achy, I feel exhausted, and I am having a hard time getting going in the morning.”

HPI

Analise Schaefer is a 54-year-old African-American woman who presents to rheumatology clinic with complaints of generalized arthralgias, fatigue, and morning stiffness. She has a 13-year history of RA currently treated with methotrexate. She reports worsening in her symptoms over the past 6 months.

PMH

RA × 13 years

Heart failure with reduced ejection fraction (currently NYHA class III)

FH

Father is alive and being treated for hypertension and osteoarthritis. Mother is alive and being treated for severe RA. Two siblings with no major health concerns.

SH

Tax accountant; married for 25 years; heterosexual, sexually active, monogamous. Denies tobacco or illicit drug use. Drinks one to two glasses of wine per week.

Meds

Methotrexate 2.5 mg, six tablets (15 mg) PO once a week

Folic acid 1 mg PO once daily

Lisinopril 40 mg PO once daily

Metoprolol succinate 100 mg PO once daily

Spironolactone 25 mg PO once daily

Furosemide 40 mg PO once daily

Patient receives medications at a local community pharmacy. Medication profile indicates that she refills her medications on time on the first of each month.

All

Sulfonamides (hives)

ROS

Complains of swelling and pain in both hands; reports decreased ROM in hands and wrists; has morning stiffness every day for about 2 hours and fatigue daily during the afternoon hours; denies HA, chest pain, bleeding episodes, or syncope; no nausea, vomiting, diarrhea, loss of appetite, or weight loss.

PE

Gen

African–American woman in moderate distress because of pain, swelling, and fatigue related to arthritis

VS

BP 118/76 mm Hg, P 62 bpm, RR 14, T 37.1°C; Wt 65 kg, Ht ...

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