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    Rheumatoid Arthritis - Case Report

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    Warren Lie
    This document summarizes a case study of a 32-year-old female patient presenting with joint pain. After taking a history and conducting a physical exam, the resident diagnosed the patient with rheumatoid arthritis based on meeting the classification criteria. Laboratory tests and x-rays were planned. Treatment recommended included DMARDs like methotrexate, NSAIDs, and supplements. The document then discusses rheumatoid arthritis including definitions, epidemiology, pathophysiology, clinical features, diagnosis criteria, and therapy options. Remission criteria and disease activity scores are also outlined.

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    Rheumatoid Arthritis - Case Report

    Uploaded by

    Warren Lie
    1K views33 pages
    This document summarizes a case study of a 32-year-old female patient presenting with joint pain. After taking a history and conducting a physical exam, the resident diagnosed the patient with rheumatoid arthritis based on meeting the classification criteria. Laboratory tests and x-rays were planned. Treatment recommended included DMARDs like methotrexate, NSAIDs, and supplements. The document then discusses rheumatoid arthritis including definitions, epidemiology, pathophysiology, clinical features, diagnosis criteria, and therapy options. Remission criteria and disease activity scores are also outlined.

    Original Description:

    Case report of RA in RSWS Makassar

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    This document summarizes a case study of a 32-year-old female patient presenting with joint pain. After taking a history and conducting a physical exam, the resident diagnosed the patient with rheumatoid arthritis based on meeting the classification criteria. Laboratory tests and x-rays were planned. Treatment recommended included DMARDs like methotrexate, NSAIDs, and supplements. The document then discusses rheumatoid arthritis including definitions, epidemiology, pathophysiology, clinical features, diagnosis criteria, and therapy options. Remission criteria and disease activity scores are also outlined.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    1K views33 pages

    Rheumatoid Arthritis - Case Report

    Uploaded by

    Warren Lie
    This document summarizes a case study of a 32-year-old female patient presenting with joint pain. After taking a history and conducting a physical exam, the resident diagnosed the patient with rheumatoid arthritis based on meeting the classification criteria. Laboratory tests and x-rays were planned. Treatment recommended included DMARDs like methotrexate, NSAIDs, and supplements. The document then discusses rheumatoid arthritis including definitions, epidemiology, pathophysiology, clinical features, diagnosis criteria, and therapy options. Remission criteria and disease activity scores are also outlined.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 33

    Department of Rheumatology

    Medicine Faculty
    Hasanuddin University

    Augustus 2016

    RHEUMATOID ARTHRITIS
    Warren Lie C11112007
    Putri Hardianti Kustanto C11112070
    RESIDENT:
    dr. Meriam Melinda

    PATIENT IDENTITY
    Name
    : Mrs. S
    Age
    : 32 years old
    Sex
    : Female
    Occupation : Housewife

    HISTORY
    Chief complaint: joint pain
    Further anamnesis:
    Felt since 2 months ago and worsen in the past week.
    The joint pain occurred in the morning, accompanied
    with stiffness of the joints. The duration of the stiffness
    is more than 30 minutes. The stiffness and pain were
    relieved by activity. There is no history of trauma,
    cough, shortness of breath, nausea, vomiting and chest
    pain. There is history fever, intermittent with no clear
    pattern. She lost 2 kg of body weight within the last
    month because of decreased appetite. History of
    treatment in a general practitioner, she was given
    analgesics but there is no improvement.

    PHYSICAL EXAMINATION
    Vital Sign
    BP: 100/70 mmHg
    RR : 20x/min
    HR: 84x/min, regular T : 36.5 oC
    Head: anemia (-), jaundice (-)
    Neck: JVP R+0 cmH20 (30o)

    PHYSICAL EXAMINATION
    CHEST EXAMINATION
    Inspection : symmetrical, no scar, ictus cordis
    not visible
    Palpation : no mass/tenderness, apex not
    palpable
    Percussion : normal heart size, liver border ICS 6
    Auscultation :
    Lung : vesicular breath sound
    Rh -/- Wh -/Heart : S1 S2 regular, murmur (-)

    PHYSICAL EXAMINATION
    ABDOMINAL EXAMINATION
    Inspection : Flat, follow breath movement
    Auscultation : Peristaltic sound (+), normal
    Palpation : No mass/tenderness, liver and
    spleen are
    not palpable
    Percussion : Tympani (+), no ascites

    RHEUMATOLOGY STATUS
    GAIT: normal
    ARM:
    PIP I V D/S tenderness (+), edema
    (-), swan neck (-), boutunniere
    deformity (-)
    - MCP I V D/S tenderness (+)
    - Wrist D/S tenderness (+)
    LEG: normal
    SPINE: normal

    LABORATORIUM
    PARAMETER

    RESULT

    NORMAL
    VALUE

    UNIT

    WBC

    6.4

    4.0 10.0

    10^3 u/L

    HGB

    10.8

    13.0 17.0

    g/dL

    MCV

    80.1

    80-100

    um3

    MCH

    28.2

    27-32

    pg

    PLT

    240

    150 - 500

    10^3 u/L

    Ureum

    22

    10 - 50

    mg/dL

    Creatinine

    0.8

    <1,3

    mg/dL

    SGOT

    20

    <38

    U/L

    SGPT

    21

    <41

    U/L

    Glucose

    98

    <140

    mg/dL

    PROBLEM LIST (1)


    RHEUMATOID ARTHRITIS
    Joint pain + stiffness in the morning
    Stiffness duration > 30 mins, relieved by
    activity
    Tenderness in more than 10 joints (PIP I V
    D/S, MCP I V D/S, wrist D/S (5 points)
    Duration of symptoms > 6 weeks (1 point)
    ACR-EULAR CLASSIFICATION CRITERIA FOR RA:
    > 6 POINTS RA

    NO DATA

    NO DATA

    PROBLEM LIST (1)


    RHEUMATOID ARTHRITIS
    Plan:
    - X-ray of hand and wrist joints D/S
    AP/lateral
    - Laboratorium: RF/ACPA, ESR

    PROBLEM LIST (1)


    RHEUMATOID ARTHRITIS
    Non-pharmacologic therapy:
    - Fish oil supplement
    - Physical exercise
    Pharmacologic therapy:
    - DMARDs: Methotrexate 10mg/week
    - Folic acid 1 mg/day
    - NSAID: Meloxicam 7,5 mg/day
    - PPI: omeprazole 40mg/d

    PROBLEM LIST (2)


    ANEMIA NORMOCYTIC NORMOCHROMIC
    Hb 10.2 mg/dL
    MCV 80.1 um3
    MCH 28.2 pg
    Plan:
    - treat underlying cause (RA)
    - Peripheral blood smear
    - if Hb drops below 10, investigate further
    iron, B12, folate studies

    Differential Diagnosis
    Characterist
    ic
    Gender
    Age

    Rheumatoid
    Arthritis
    Female > Male
    20 - 50 years old

    Osteoarthritis

    Gout Arthritis

    Female > Male

    Male > Female

    > 50 years old

    Men : >35 years


    Women : after
    menopause

    Pain & swelling on


    major weight
    A type of arthritis
    Inflammation in
    bearing joints,
    that causes
    multiple joints,
    stiffness,
    inflammation,
    Symptoms
    morning stiffness >
    crepitation,
    usually in one joint,
    30 mins
    tenderness,
    that begins
    morning stiffness <
    suddenly
    30 mins
    Weight bearing
    1st
    Small joints (PIP, MCP,
    Location
    joints (genu, hip, Metatarsophalange
    MTP)
    vertebra)
    al Joints
    Symmetrical
    Symmetry
    Asymmetry
    Asymmetry
    Pathological

    Additional Physical
    Examination

    Inspection :
    Deformity of the joints (Swan Neck deformity,
    Boutonniere deformity, ulnar deviation)

    RHEUMATOID ARTHRITIS

    DISCUSSION

    DEFINITION
    Rheumatoid arthritis (RA) is a chronic
    inflammatory disease of unknown
    etiology
    marked
    by
    symmetric,
    peripheral polyarthritis.

    EPIDEMIOLOGY
    woman > man 2-3:1
    Infection factor
    Heat shock protein

    PATHOPHYSIOLOGY

    CLINICAL FEATURES
    ARTICULAR
    Early morning joint stiffness, easing
    with physical activity
    Predilection: wrist, MCP, PIP joints.
    DIP rare.
    Ulnar deviation, trigger fingers,
    swan-neck deformity, boutonniere
    deformity, Z-line deformity

    CLINICAL FEATURES
    EXTRAARTICULAR
    - Constitutional
    - Nodules
    - Sjogren syndrome
    - Pulmonary
    - Cardiac
    - Vasculitis
    - Hematologic
    - Lymphoma

    DIAGNOSIS CRITERIA

    THERAPY

    NSAIDs
    Glucocorticoids : prednisone 10 mg/d
    DMARDs
    Methotrexate 10-25 mg/w
    Leflunomide 10-20 mg/d
    Sulfasalazine 500mg 2x1 1000-1500mg 2x1
    Hydroxychloroquine 200-400 mg/d
    Biologic DMARDs
    TNF-alpha inhibitor: Infliximab, Etanercept, Adalimumab,
    Golimumab, Certolizumab
    - Abatacept
    - Rituximab
    - Toclizumab

    THANK YOU.

    REMISSION CRITERIA
    ACR
    1. Stiffness in the morning less then 15
    minutes
    2. No fatigue
    3. No joint pain
    4. No pain on pressure or in movement
    5. No swelling of joint
    6. ESR lessthan 20mm/ hour for the male,
    30mm/hour

    AKTIVITAS NILAI
    NILAI
    PENYAKIT DAS28-LED DAS28CRP
    REMISI
    2,6
    2,3
    RENDAH
    3,2
    2,7
    SEDANG
    >3,2 S/D
    >2,7 S/D
    5,1
    4,1
    TINGGI
    >5,1
    >4,1

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