EXERCISE NO.

A Case Study on Rheumatological Diseases

Rheumatological Arthritis (RA) is a systemic disease of unknown etiology characterized by symmetric

inflammatory polyarthritis. The course is variable but tends to be chronic and progressive.

The hallmark of RA is synovial inflammation and proliferation leading to pannus formation. The initiating
stimulus is unknown but may be an infectious agent. RA can range from a self-limited illness involving a
few joints to a progressive polyarthritis with multiple associated extra articular manifestations.

Joint disease typically begins insidiously with pain, stiffness, swelling, and limitation of motion. Stiffness in
moving often relieved with joint use. The hands are most frequently involved with swelling of the proximal
interphalangeal and metacarpophalangeal joints, often with a relative sparing of the distal interphalangeal
joints. Progressive disease can lead to deformity with ‘swan neck’ or boutonniere deformities.

No curative therapy is available, but most patients can benefit from a combined program of medical,
surgical, and rehabilitative services. Management has three goals:

1. Suppression of inflammation in the joints and other tissues;

2. Maintenance of joint function and prevention deformities; and

3. Repair of joint damage when such repair will relieve pain or improve function.

In addition, joint rest, joint, protection, and exercise are important aspects of therapy. In Medical
Management, the following drugs are usually employed:

Salicylates

Non-steroidal anti-inflammatory drugs

Gold salts

Penicillamine

Hydroxychloroquine

Glucocorticoids

Immune suppressive agents

Surgical management is sometimes indicated in patients with RA in an attempt to reduce pain and improve

function.
Case Presentation

CC: M. T. is a 70-year old obese female. She went to the clinic for evaluation of her arthritis. She
complained of increased swelling and pain in her hands, ankles, and knees.

Past Medical History

M. T. has been suffering from arthritis for 10 years. She has taken different drugs like ASA, Ibuprofen and
Naprosyn at maximal doses. She has been suffering from gout for three years. She suffered acute attacks
a month ago after having had multiple acute attacks. She has hyperuricemias with a history of uric acid
stone formation; she had deep venous thrombosis two months ago, has had congestive heart failure for
one year, hypertension, and renal insufficiency.

Medication History

Piroxicam 20mg p.o. q.d. x 4 months

Buffered ASA 325mg p.o. prn

Furosemide 40mg p.o. q A.M.

Probenecid 250mg p.o. bid

Colchicine 0.5mg p.o. qd

Warfarin 5mg p.o. qd

Digoxin 0.625mg p.o. qd x 6 months

Allergies

Chloroquine

Penicillamine – rash

Social History

Ethanol: 1 pint of table wine per day

Tobacco: 1 pack per day for 50 years

Physical Examination

Gen : M. T. is pale, obese, moderate distress.

VS : BP 14/90

HR 85

Wt 72 kg (ideal wt. 60 kg)

Chest : Mild bilateral rales

COR : Positive S3 and S4

Results of Laboratory Tests

Na 140 Hct 27

K 4 Hgb 8.5

Cl 100 WBC 6.5

HCO3 26 Uric Acid 12

BUN 40 PT 18

Cr 2.4 Digoxin 0.6

Chest x-ray: Enlarged Heart

Assessment of the case presented:

Symptoms and ______________________________________________________________

Characteristics ______________________________________________________________
of the disease ______________________________________________________________

Laboratory test ______________________________________________________________

with abnormal ______________________________________________________________
values ______________________________________________________________

Disease associated ______________________________________________________________

with abnormal ______________________________________________________________
laboratory resul t ______________________________________________________________

Medication given ______________________________________________________________

for the treatment ______________________________________________________________
of the disease ______________________________________________________________

Interactions, if any ______________________________________________________________

is ______________________________________________________________
of ______________________________________________________________

Appropriate drug/ ______________________________________________________________

procedure to avoid ______________________________________________________________
interactions or to ______________________________________________________________
improve patient’s
condition
Questions:

1. What are the most common untoward reactions of nonsteroidal anti-inflammatory agents used in the
treatment of rheumatoid arthritis?
Answer:

2. Give the different generic drugs classified as nonsteroidal anti-inflammatory agents.

Answer:

3. In tabulated form, give the application, dosage. Side effects of the different drugs used in the
management of arthritis.
Answer:

4. Which is the most potent anti-inflammatory drugs available?

Answer:

5. Which is the first-line therapy for patients with RA? How many its GI intolerance be avoided?
Answer: