Mercado, Reuben Mari S.

MUSC 250

Rheumatology OPD (Nov. 11, 2019)

GENERAL DATA
Name: Timtim, Rowena
Age: 49 years old
Sex: Female
Civil Status: Married
Address: Taguig City
Province: Nueva Ecija
Religion: Jehovah’s Witness
Occupation: Former seamstress
Handedness: Right
Date of Consult: November 11, 2019 (Monday)
Diagnosis: Plaque-type Psoriatic Arthritis, Osteoarthritis of the knees, and
Anserine Bursitis

 Diagnostic Work-up
o CBC: for baseline data
o ESR and CRP: Inflammatory markers
o Liver function tests (ALT, AST, TPAG): for baseline data due to history of untreated Hepatitis B and also
assess function of liver
o Lipid Profile: has high risk of complication if significant due to comorbidity (HTN)
o Renal Function tests (Creatinine, BUN): in order to adjust medicines if significant
o 75-OGTT and HbA1c: assess glucose tolerance because of high risk of having DM due to medications and
family history
o X-ray (AP-O hands and AP-L knees): check for erosive changes and new bone formation and watch out for
“pencil-in-cup” appearance which is suggestive of gross destruction of the joint. Also to assess the
osteoarthritis of the knees.
 Treatment Plan
o Nonpharmacologic Treatment
 Exercise, physical therapy, and occupational therapy: in order to address limitations on movements of
the hands and be educated regarding joint protection
 Weight reduction: these comorbidities must be addressed in order to lessen loading on the knees and
also to lessen risk of CVDs. According to studies, high BMI may lessen treatment response to
DMARDs and/or biologics so appropriate intervention will likely yield positive response.
 Patient education: inform the patient regarding aggravating factors like stress and educate the patient
regarding the importance of addressing the comorbidities such as high BMI, hypertension, adherence
to medications, and proper use of topical and oral medications.
 Warm compress on patient’s knees in order to alleviate the pan.
o Pharmacologic Treatment
 Since patient is responsive to NSAIDs, naproxen 375 to 500 mg twice daily or celecoxib 200 mg twice
daily may be initiated as first-line therapy for the inflammation and pain.
 Thinking forward, if the patient’s condition is resistant to NSAIDs and since methotrexate is not
possible due to patient’s current liver function, DMARDs (Sulfasalazine, azathioprine, and apremilast)
and TNF inhibitor may be used. But cost must be evaluated following the patient’s financial capability.
 Comorbidities must also be addressed such as the hypertension (Stage 1 Hypertension ave: 130/90
mmHg).