Original Case Study Patient is a 48-year-old male with complaints of stiffness i
Original Case Study Patient is a 48-year-old male with complaints of stiffness in his fingers that migrates to his upper arm joints and increased fatigue over the last few months. The patient works in a bank and types frequently. He commented that he thought he could have carpal tunnel syndrome, but the fatigue was beginning to worry him. The patient reports a family history of rheumatoid arthritis. He is currently taking Motrin for pain which partially relieves the symptoms. He rates his pain a 5/10 at present, aching in both hands. The patient’s vital signs are 120/80, Pulse 78, Res 16, Temp 100.1 F. He denies any recent weight changes. Physical exam reveals: Edema to 4th and 5th PIP joints bilaterally with tenderness in the same joints. His grip strength is decreased bilaterally. No edema of knees or ankles noted. Main Post Based on the symptoms reported and physical examination findings, the disease suggested in this patient is rheumatoid arthritis (RA). Joint inflammation is characteristic of rheumatoid arthritis, an autoimmune disease. An inflammatory response causes pain, swelling, and stiffness in the affected joints—an immune response attacking healthy joint tissue results in RA. Synoviocytes become activated and undergo changes, producing numerous pro-inflammatory substances, such as cytokines and matrix metalloproteinases, which further exacerbate the inflammatory response.T cells and B cells in the immune system also play a role in disease progression. T cells can directly attack synovial cells, leading to inflammation. B cells can produce antibodies that target joint tissues, leading to further damage. Genetic Influence on the Disease Genetics and environment work together to determine most traits. (McCance & Felver, p 176, 2019). There is a vital genetic component to rheumatoid arthritis. Research suggests that specific genes, such as HLA-B27, coding for proteins involved in immune regulation, can increase the risk of developing the disease. However, it is essential to note that genetic susceptibility alone does not determine an individual’s risk of developing rheumatoid arthritis. Environmental factors, such as infections and lifestyle choices, also contribute to the development of the disease. Presentation of Specific Symptoms The patient’s specific symptoms of stiffness in his fingers that migrates to his upper arm joints and increased fatigue suggest a possible diagnosis of rheumatoid arthritis. The stiffness and migratory nature of symptoms observed in this patient are characteristic features of rheumatoid arthritis. Rheumatoid arthritis symptoms often include stiff joints in the morning for longer than 30 minutes, fatigue, fever, weight loss, and tender, warm joints. (Bullock et al., 2018). Physiologic Response to Stimulus It is possible to attribute the body’s response to the presence of rheumatoid arthritis in this scenario to its immune response. An overactive immune system mischaracterizes rheumatoid arthritis attacks and destroys healthy joint tissues. The inflammation induced by the disease leads to swelling, pain, and stiffness in the affected areas. The migrating nature of the symptoms in this patient, from the fingers to the upper arm joints, suggests the involvement of shared nerves or connective tissues, further supporting the diagnosis. Characteristics Change Regarding another characteristic changing our response, it is essential to note that this patient’s gender is not mentioned in the provided information. However, if this was a female patient, it might have implications for diagnosing and managing the presenting symptoms. For example, rheumatoid arthritis, which the patient has a family history of, occurs in women more frequently than men. Women in their 30s to 50s are most likely to be affected by RA, with an incidence rate of 1 in 150. (Tanaka, 2020). Additionally, studies have reported a higher prevalence of carpal tunnel syndrome in women compared to men. Therefore, if the patient were female, it would be essential to consider these gender-specific factors when evaluating her symptoms. However, in terms of genetics, the patient’s family history of rheumatoid arthritis may play a crucial role in evaluating his condition. Rheumatoid arthritis is a genetic disease, and it is thought that specific genetic markers contribute to the risk of developing this condition. Therefore, a family history of rheumatoid arthritis raises the possibility that the patient may have inherited certain genetic traits that make them more susceptible to developing rheumatoid arthritis. Considering this information, the physical examination findings, and the patient’s reported symptoms, a diagnosis of rheumatoid arthritis should be considered in this patient. The presence of edema and tenderness in the PIP joints decreased grip strength, and a family history of rheumatoid arthritis supports this diagnosis. Additionally, the patient’s pain, which only partially responds to Motrin, suggests a possible inflammatory component, which is common in rheumatoid arthritis. Reference Bullock, J., Rizvi, Syed A. A., Saleh, Ayman M., Ahmed, Sultan S., Do, Duc P., Ansari, Rais A., & Ahmed, J. (2018). Rheumatoid Arthritis: A Brief Overview of the Treatment. Medical Principles and Practice, 27(6), 501–507. https://doi.org/10.1159/000493390Links to an external site. Mccance, K. L., & Felver, L. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. Tanaka, Y. (2020). Rheumatoid arthritis. Inflammation and Regeneration, 40(1). https://doi.org/10.1186/s41232-020-00133-8Links to an external site.